Rapidly progressive glomerulopathy in a patient with hepatitis C virus not diagnosed. Case Report.
Oscar G. Galindo-Contreras1, Alfredo Lom-García2, Jimena Sánchez-Zumaya1, Nicolás Sánchez-Rodríguez3, Clara C. Sánchez-Rodríguez1
1 Department of Internal Medicine, Regional General Hospital 6, Madero City, Tamaulipas, México, Instituto Mexicano del Seguro Social (IMSS)
2 Department of Pathology. Regional General Hospital 6, Madero City, Tamaulipas, México. Instituto Mexicano del Seguro Social (IMSS)
3 Department of Oncological Surgery. Regional General Hospital 6, Madero City, Tamaulipas, México. Instituto Mexicano del Seguro Social (IMSS)
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Galindo-Contreras, Alfredo Lom-García, Jimena Sánchez-Zumaya, Nicolás Sánchez-Rodríguez, Clara C. Sánchez-Rodríguez" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Oscar G." "apellidos" => "Galindo-Contreras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] ] ] 1 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Lom-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0002" ] ] ] 2 => array:3 [ "nombre" => "Jimena" "apellidos" => "Sánchez-Zumaya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] ] ] 3 => array:3 [ "nombre" => "Nicolás" "apellidos" => "Sánchez-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0003" ] ] ] 4 => array:3 [ "nombre" => "Clara C." "apellidos" => "Sánchez-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Internal Medicine, Regional General Hospital 6, Madero City, Tamaulipas, México, Instituto Mexicano del Seguro Social (IMSS)" "etiqueta" => "1" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Pathology. Regional General Hospital 6, Madero City, Tamaulipas, México. Instituto Mexicano del Seguro Social (IMSS)" "etiqueta" => "2" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Department of Oncological Surgery. Regional General Hospital 6, Madero City, Tamaulipas, México. Instituto Mexicano del Seguro Social (IMSS)" "etiqueta" => "3" "identificador" => "aff0003" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical statement</span></p><p id="para0006" class="elsevierStylePara elsevierViewall">The identity of the patients is protected. Consentment was obtained.</p><p id="para0007" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Declaration of interests</span></p><p id="para0008" class="elsevierStylePara elsevierViewall">None</p><p id="para0009" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Funding</span></p><p id="para0010" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.<elsevierMultimedia ident="fig0001"></elsevierMultimedia></p><p id="para0011" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Figure 1.</span> Light micrograph, renal biopsy. a, b: Jones' metamine stain, showing a thickened Bowman's capsule, folded, without spicules or filling defects with the stains used, fibrous crescents with an index of interstitial fibrosis 30-35%. c, d. HE stain, glomerulus with extra capillary proliferative and segmenting extra capillary proliferative lesions partially the tangles, cariorexis and fibrinoid necrosis. e, f: Masson's trichome stain, interstitium tubular with fibrosis and atrophy, scant infiltrate inflammatory whith lymphocytes and cells plasmatic, tubular epithelium with regenerative changes accentuated and intratubular proteinaceous material. Negative immunofluorescence (IgA, G4, kappa, C3), not showed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001">Introduction and Objectives</span><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Hepatitis C virus (HCV) related-Kidney disease, mostly due to the formation of immune complexes and cryoglobulins with cryoglobulinemic vasculitis (CryoVas), and a direct cytopathic effect. We present a case of HCV-nephritic syndrome associated with focal segmental glomerulosclerosis without CryoVas that reported anecdotally in the literature.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Materials and Patients</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">63-year-old female with 15 years of stable essential hypertension. She suddenly presented lower extremity edema, headache, phosphenes, hypertensive uncontrol, hematuria, proteinuria and decreased glomerular filtration. She received steroids with partial response, for which phenolic acid was started after six months without complete response. A renal biopsy with immunofluorescence, serum antinuclear antibodies (SS-A, SS-B, Sm, RNP, Jo1, Scl70, dsDNA, ANCA-c, ANCA-p, anticardiolipin, cryoglobulins) rheumatoid factor, C4 electrophoresis of immunoglobulins and liver function tests carry out.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Results</span><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">All liver and immunological parameters was normal. The renal biopsy were atypical damage associated with HCV finding focal segmental glomerulosclerosis with areas of extra-capillary proliferative glomerulosclerosis pauci-immune, shown in Figure 1. Hepatitis C serology and viral load were positive, she received glecaprevir/pibrentasvir for 12 weeks with a sustained viral response at week 12. During the 3-year follow-up, the patient is on peritoneal dialysis, with no viral relapse.</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Conclusions</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">We should emphasize that the control of focal segmental glomerulosclerosis-associated nephritic syndrome was achieved with direct-acting antivirals (AAD). This type of kidney injury is described as a direct lesion from virus replication to direct injury to podocytes, so the isolated use of other immunosuppressive therapies (steroids/immunosuppressors) can accelerate the renal damage, early identification of HCV involvement is necessary to start appropriate treatment with AAD as soon as possible.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Materials and Patients" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0001" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr31.jpeg" "Alto" => 1965 "Ancho" => 1500 "Tamanyo" => 450881 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Unlabelled imag" "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/00000029000000S2/v2_202404250742/S1665268124002278/v2_202404250742/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/16652681/00000029000000S2/v2_202404250742/S1665268124002278/v2_202404250742/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268124002278?idApp=UINPBA00004N" ]
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