Prevalence of Cryoglobulinemia and its relation to Renal Affection in Hepatitis C Virus Related Liver Disease

Abstract

 No doubt, HCV is a real health problem worldwide. The prevalence in Egypt is relatively high. HCV is associated with a wide range of extra-hepatic complications, and it is increasingly recognized as an instigator of B cell lympho-proliferative disorders including cryoglobulinemia.  Estimates of cryoglobulinemia prevalence in HCV infection vary widely, ranging from 10-90% or even 100%; many of these differences may be due to population selection and lead time biases. Additionally, the clinical assessment of cryoglobulinemia is not standardized, and the laboratory test for cryoglobulinemia is prone to false negative results.  Renal involvement has been frequantly reported in the setting of HCV infection. and the main pathogenesis of renal dyfuction often mediated by cryoglobulins has not been fully elucidated.  The present study was done to improve the degree of involvement of cryoglobulinemia in renal affection in HCV patients.  100 patients with HCV related liver disease (chronic hepatitis and liver cirrhosis) (Group 1) and 20 healthy subjects were included as a control group (Group 2). All the studied patients were subjected to a full history taking, a thorough clinical examination, a full laboratory investigation, C3 and C3, RF, Cryoglobulins precipitation test and Semi-quantitative detection of Cryoglobulins by cryocrit.  Estimation of GFR, pr/cr ratio and creatinine level were central to the diagnosis of renal affection.  From 100 HCV patients related liver disease 33 of them having renal affection with different causes including glomerulonephritis (20), HRS (6), hematemesis (5) and gastroenteritis (2).  From those 20 patients with glomerulonephritis only 8 of them were cryoglobulins positive and the remaining 12 were negative.  There were 24 patients having cryoglobulinemia and with normal kidney function.  When HCV patients with cryoglobulinemia were compared to a group to those without cryoglobulinemia, the severity of liver disease was higher in the cryoglobulinemia positive group. And there was positive significant correlation between the serum cryoglobulins level and severity of liver disease. Although, in patients with mixed cryoglobulinemic glomerulonephritis, correlation between serum cryoglobulins level and severity of the disease was not significant.  The presence of cryoglobulins in HCV related liver disease is correlated to the severity of liver disease. Patients may have MC without renal affection even when serum cryoglobulins levels are high, and others had renal affection without MC.  Also, in those patients having MC with renal affection the MC almost was not the cause for this affection.  And this indicate that MC is not the main accused factor responsible for renal affection in HCV related liver disease and there are other causes implicated.  The health care providers should screen for cryoglobulinemia in HCV patients with advanced liver disease (Child C) and for HCV in patients with cryoglobulinemic manifestation.  HCV patients with positive cryoglobulins and clinically asymptomatic usually do not need any treatment, even in the presence of high levels of cryocrit. In all cases, a careful clinical monitoring of the disease is mandatory.