Nephrol Dial Transplant (2000) 15 [Suppl 8]: 28–33 Nephrology Dialysis Transplantation Glomerular disease associated with hepatitis C virus infection in native kidneys Claire Pouteil-Noble, Hakim Maiza, Fre ´derique Dijoud and Brigitte MacGregor Transplantation and Nephrology Unit, Centre Hospitalier Lyon-Sud, 69495 Pierre-Be ´nite Cedex, France Introduction Constancy and reproducibility of the association Is there an increased prevalence of glomerulopathies Many glomerular diseases have been described in asso- ciation with liver diseases, associated or not with viral in general or of particular types of glomerulopathy? In native kidneys, the prevalence of HCV is higher in infection such as hepatitis B virus (HBV ) or hepatitis C virus (HCV ) infections. Among the glomerulopath- patients with glomerulonephritis, especially those with secondary glomerulonephritis (12/72 (16.7%)) than in ies, membranous glomerulopathy (MN) and IgA nephropathy are the most frequently found in HBV- patients with other causes of kidney diseases (6/154 (4%)) [5]. In this study, the prevalence in the general infected patients [1] and MN and membrano- proliferative glomerulonephritis (MPGN), with or population was ~1.03% in blood donors. However, the prevalence of glomerulonephritis in HCV-positive without cryoglobulinaemia, are the most frequently glomerulopathies described in association with HCV patients in the general population is not known. Published data on the prevalence of HCV-seropositive infection [2]. Epidemiological arguments for a simple association or a causal effect between HCV infection and -seronegative patients in each type of glomerulo- nephritis are reviewed below. and glomerular diseases are discussed below. Focal glomerulosclerosis and minimal glomerular The temporal sequence of events: does HCV changes infection occur before glomerulonephritis? Between 1993 and 1999, results from nine series of patients with focal glomerulosclerosis (FSGS ) or min- In the first case reports of an association between imal glomerular changes were published [6–14]: in 296 MPGN and HCV infection in native kidneys, HCV patients with FSGS or minimal glomerular changes, serology was assessed at the same time as the renal 13 patients were HCV positive, corresponding to a biopsy [3], so earlier HCV status and, hence, the prevalence of 4.39%, which was not significantly duration of HCV disease before the occurrence of different from that of the general population. glomerulonephritis are usually not known. The situ- Confounding factors must be stressed for FSGS. For ation is different in renal transplantation, since renal example, drug abuse and HIV infection are common transplant patients have their HCV serology known at causes of both FSGS and HCV infection: Stehman- the time of transplantation and the transplanted kidney Breen et al. [14] reported that, of 12 patients with is usually free of any glomerular disease as it is assessed FSGS, six were HCV positive and five of these six by a pre-transplant donor biopsy routinely performed patients were intravenous drug abusers. in some centres. Moreover, the donor is usually seronegative for HCV, at least in France. IgA nephropathy In a cohort of 1098 renal transplant patients, the prevalence of de novo glomerulonephritis was signific- For IgA nephropathy, nine series were reported antly higher in HCV-infected patients at the time of between 1993 and 1998 [6–11,13,15,16]. Of 331 transplantation (22.5% (18/81)) than in HCV-sero- patients with IgA nephropathy, only seven were HCV negative patients (8.5% (28/328)) ( P<0.02); patients positive, corresponding to a prevalence of 2.1%, not with recurrent glomerulopathies and with HBV infec- different from that of the general population con- tion were excluded. De novo MPGN were observed sidering the geographic origin of the patients, mainly only in HCV-infected patients [4]. from Italy and Spain. Stro ¨m et al. [17] analysed the association between IgA and HCV infection from an Correspondence and offprint requests to: Prof. Claire Pouteil-Noble, autopsy series in cirrhotic patients: of 27 patients, 13 Transplantation and Nephrology Unit, Centre Hospitalier Lyon-Sud, 69495 Pierre-Be ´nite Cedex, France. had IgA nephropathy and only two were HCV infected, © 2000 European Renal Association–European Dialysis and Transplant Association