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Brief Communication: Glomerulonephritis in Patients with Hepatitis C Cirrhosis Undergoing Liver Transplantation

Brendan M. McGuire, MD, MS; Bruce A. Julian, MD; J. Steve Bynon Jr, MD; William J. Cook, MD, PhD; Steven J. King, MD, PhD; John J. Curtis, MD; Neil A. Accortt, PhD; and Devin E. Eckhoff, MD
[+] Article and Author Information

From University of Alabama at Birmingham, Birmingham, Alabama.


Note: A preliminary report of this study was submitted to the American Association for the Study of Liver Diseases 56th Annual Meeting and Postgraduate Course, San Francisco, California, 11-15 November 2005.

Acknowledgments: The authors thank Mrs. Pamela R. Davis and Mrs. Leila L. Avant for assistance in compilation of the data, Dr. Britt B. Newsome for assistance in analysis of the data, Dr. Jan Novak for his insight on immune complexes and renal disease, and Drs. Michael B. Fallon and Joseph R. Bloomer for editorial suggestions.

Grant Support: By Roche Pharmaceuticals, Inc.

Potential Financial Conflicts of Interest: Grants received: B.M. McGuire (Roche Pharmaceuticals, Inc.), S.J. King (Roche Pharmaceuticals, Inc.), D.E. Eckhoff (Roche Pharmaceuticals, Inc.); Honoraria: B.M. McGuire (Roche Pharmaceuticals, Inc.).

Requests for Single Reprints: Brendan M. McGuire, MD, MS, University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 262A, Birmingham, AL 35294-0005; e-mail, bmcguire@uab.edu.

Current Author Addresses: Dr. McGuire: University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 262A, Birmingham, AL 35294-0005.

Drs. Julian and Curtis: University of Alabama at Birmingham, 1530 Third Avenue South, THT 643, Birmingham, AL 35294-0006.

Dr. Bynon: University of Alabama at Birmingham, 1530 Third Avenue South, LHRB 722, Birmingham, AL 35294-0007.

Dr. Cook: University of Alabama at Birmingham, 1530 Third Avenue South, KB 603, Birmingham, AL 35294-7331.

Dr. King: University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 274, Birmingham, AL 35294-0005.

Dr. Accortt: Cancer Prevention Institute, 601 West Riverview Avenue, Dayton, OH 45406.

Dr. Eckhoff: University of Alabama at Birmingham, 1530 Third Avenue South, LHRB 710, Birmingham, AL 35294-0007.

Author Contributions: Conception and design: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, J.J. Curtis, D.E. Eckhoff.

Analysis and interpretation of the data: B.M. McGuire, B.A. Julian, W.J. Cook, N.A. Accortt.

Drafting of the article: B.M. McGuire, B.A. Julian, W.J. Cook.

Critical revision of the article for important intellectual content: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, S.J. King, J.J. Curtis, N.A. Accortt, D.E. Eckhoff.

Final approval of the article: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, S.J. King, J.J. Curtis, N.A. Accortt, D.E. Eckhoff.

Provision of study materials or patients: B.M. McGuire.

Statistical expertise: B.M. McGuire, N.A. Accortt.

Obtaining of funding: B.M. McGuire, J.S. Bynon Jr., D.E. Eckhoff.

Administrative, technical, or logistic support: B.M. McGuire.

Collection and assembly of data: B.M. McGuire, J.S. Bynon Jr., W.J. Cook, S.J. King, D.E. Eckhoff.


Ann Intern Med. 2006;144(10):735-741. doi:10.7326/0003-4819-144-10-200605160-00007
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An immune-complex glomerulonephritis, characterized by IgA deposits and some mesangial hypercellularity, was very common in patients with end-stage cirrhosis due to chronic HCV infection. Three types of disease were observed: MPGN type 1, IgA nephropathy, and mesangial glomerulonephritis. These distinctive patterns were not associated with any demographic variable tested. The immunoglobulin staining in MPGN type 1 differed from that in patients with idiopathic MPGN; IgA was much more frequent (8). Cryoglobulins, often found in HCV-infected patients with MPGN (9), were not detected, even in rheumatoid factor–positive patients with urinary abnormalities. Subendothelial deposits were more common in patients with IgA nephropathy than in those with idiopathic IgA nephropathy (10).

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Figure.
Features of glomeruli in a kidney biopsy specimen from a 49-year-old white man with mesangial glomerulonephritis.ABCDEF

Serum creatinine level, results of urinalysis, and urinary protein–creatinine ratio were normal before surgery. Light microscopy (original magnification, × 200) showed increased mesangial matrix and proliferation of mesangial cells, indicated by black arrows ( : hematoxylin–eosin stain; : periodic acid–Schiff and hematoxylin stain). Immunofluorescence microscopy, using polyclonal IgG antibodies (original magnification, × 400), showed deposits only in the mesangium; these deposits were graded on a scale of 0 to 4+ as 3+ for IgG ( ), 1+ for IgA ( ), and 4+ for C3 ( ). Background staining outlines the peripheral capillary walls. Electron microscopy (original magnification, × 12  600) showed numerous large, electron-dense deposits, indicated by the black arrow, in the mesangium ( ). The capillary wall was mildly thickened but contained no deposits.

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