Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of renal disease associated with hepatitis C virus infection

Nassim Kamar, MD, PhD
Lionel Rostaing, MD, PhD
Section Editors
Richard J Glassock, MD, MACP
Martin S Hirsch, MD
Deputy Editor
Albert Q Lam, MD


There is a strong and likely causal association between chronic hepatitis C virus (HCV) infection and glomerular disease [1-4]. Several types of renal disease have been recognized including mixed cryoglobulinemia, membranoproliferative glomerulonephritis (MPGN), membranous nephropathy [5-11], and polyarteritis nodosa (PAN). Crescentic glomerulonephritis may be superimposed on any of these glomerular lesions.

Less commonly, other glomerular lesions have been reported in HCV-infected patients, including focal segmental glomerulosclerosis (FSGS) [12-14], proliferative glomerulonephritis [15-17], and fibrillary [18-20] and immunotactoid glomerulopathies [19]. In some patients, glomerular disease may be clinically silent [21,22]. (See 'Types of glomerular disease associated with hepatitis C infection' below.)

Glomerular diseases associated with HCV can also occur in renal allografts. These issues are presented in detail elsewhere. (See "Hepatitis C infection in kidney transplant candidates and recipients".)

This topic provides an overview of the renal diseases associated with chronic HCV infection. The diagnosis of HCV infection, treatment of HCV infection in patients with kidney disease, and evaluation and management of HCV-associated renal disease following renal transplantation are discussed in other topics. (See "Diagnosis and evaluation of chronic hepatitis C virus infection" and "Treatment of chronic hepatitis C infection in adults with renal impairment" and "Hepatitis C infection in kidney transplant candidates and recipients".)


The major glomerular diseases associated with hepatitis C virus (HCV) infection include the following:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Jun 13, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Morales JM, Kamar N, Rostaing L. Hepatitis C and renal disease: epidemiology, diagnosis, pathogenesis and therapy. Contrib Nephrol 2012; 176:10.
  2. Sabry AA, Sobh MA, Irving WL, et al. A comprehensive study of the association between hepatitis C virus and glomerulopathy. Nephrol Dial Transplant 2002; 17:239.
  3. Sumida K, Ubara Y, Hoshino J, et al. Hepatitis C virus-related kidney disease: various histological patterns. Clin Nephrol 2010; 74:446.
  4. Castillo I, Martinez-Ara J, Olea T, et al. High prevalence of occult hepatitis C virus infection in patients with primary and secondary glomerular nephropathies. Kidney Int 2014; 86:619.
  5. Johnson RJ, Willson R, Yamabe H, et al. Renal manifestations of hepatitis C virus infection. Kidney Int 1994; 46:1255.
  6. Misiani R, Bellavita P, Fenili D, et al. Hepatitis C virus infection in patients with essential mixed cryoglobulinemia. Ann Intern Med 1992; 117:573.
  7. Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med 1992; 327:1490.
  8. Sansonno D, Gesualdo L, Manno C, et al. Hepatitis C virus-related proteins in kidney tissue from hepatitis C virus-infected patients with cryoglobulinemic membranoproliferative glomerulonephritis. Hepatology 1997; 25:1237.
  9. Johnson RJ, Gretch DR, Yamabe H, et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med 1993; 328:465.
  10. Daghestani L, Pomeroy C. Renal manifestations of hepatitis C infection. Am J Med 1999; 106:347.
  11. Beddhu S, Bastacky S, Johnson JP. The clinical and morphologic spectrum of renal cryoglobulinemia. Medicine (Baltimore) 2002; 81:398.
  12. Cosio FG, Roche Z, Agarwal A, et al. Prevalence of hepatitis C in patients with idiopathic glomerulopathies in native and transplant kidneys. Am J Kidney Dis 1996; 28:752.
  13. Altraif IH, Abdulla AS, al Sebayel MI, et al. Hepatitis C associated glomerulonephritis. Am J Nephrol 1995; 15:407.
  14. Stehman-Breen C, Alpers CE, Fleet WP, Johnson RJ. Focal segmental glomerular sclerosis among patients infected with hepatitis C virus. Nephron 1999; 81:37.
  15. Morales JM, Morales E, Andrès A, et al. Glomerulonephritis associated with hepatitis C virus infection. Curr Opin Nephrol Hypertens 1999; 8:205.
  16. Horikoshi S, Okada T, Shirato I, et al. Diffuse proliferative glomerulonephritis with hepatitis C virus-like particles in paramesangial dense deposits in a patient with chronic hepatitis C virus hepatitis. Nephron 1993; 64:462.
  17. Johnson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of alpha-interferon therapy. Kidney Int 1994; 46:1700.
  18. Coroneos E, Truong L, Olivero J. Fibrillary glomerulonephritis associated with hepatitis C viral infection. Am J Kidney Dis 1997; 29:132.
  19. Markowitz GS, Cheng JT, Colvin RB, et al. Hepatitis C viral infection is associated with fibrillary glomerulonephritis and immunotactoid glomerulopathy. J Am Soc Nephrol 1998; 9:2244.
  20. Radhakrishnan J, Uppot RN, Colvin RB. Case records of the Massachusetts General Hospital. Case 5-2010. A 51-year-old man with HIV infection, proteinuria, and edema. N Engl J Med 2010; 362:636.
  21. McGuire BM, Julian BA, Bynon JS Jr, et al. Brief communication: Glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med 2006; 144:735.
  22. Arase Y, Ikeda K, Murashima N, et al. Glomerulonephritis in autopsy cases with hepatitis C virus infection. Intern Med 1998; 37:836.
  23. Perico N, Cattaneo D, Bikbov B, Remuzzi G. Hepatitis C infection and chronic renal diseases. Clin J Am Soc Nephrol 2009; 4:207.
  24. Rostoker G, Deforges L, Ben Maadi A, et al. Low prevalence of antibodies to hepatitis C virus among adult patients with idiopathic membranoproliferative type I glomerulonephritis in France. Nephron 1995; 69:97.
  25. Yamabe H, Johnson RJ, Gretch DR, et al. Hepatitis C virus infection and membranoproliferative glomerulonephritis in Japan. J Am Soc Nephrol 1995; 6:220.
  26. Madala ND, Naicker S, Singh B, et al. The pathogenesis of membranoproliferative glomerulonephritis in KwaZulu-Natal, South Africa is unrelated to hepatitis C virus infection. Clin Nephrol 2003; 60:69.
  27. Stehman-Breen C, Alpers CE, Couser WG, et al. Hepatitis C virus associated membranous glomerulonephritis. Clin Nephrol 1995; 44:141.
  28. Uchiyama-Tanaka Y, Mori Y, Kishimoto N, et al. Membranous glomerulonephritis associated with hepatitis C virus infection: case report and literature review. Clin Nephrol 2004; 61:144.
  29. Morales JM, Pascual-Capdevila J, Campistol JM, et al. Membranous glomerulonephritis associated with hepatitis C virus infection in renal transplant patients. Transplantation 1997; 63:1634.
  30. Cacoub P, Lunel-Fabiani F, Du LT. Polyarteritis nodosa and hepatitis C virus infection. Ann Intern Med 1992; 116:605.
  31. Ramos-Casals M, Muñoz S, Medina F, et al. Systemic autoimmune diseases in patients with hepatitis C virus infection: characterization of 1020 cases (The HISPAMEC Registry). J Rheumatol 2009; 36:1442.
  32. Beuthien W, Mellinghoff HU, Kempis Jv. Vasculitic complications of interferon-alpha treatment for chronic hepatitis C virus infection: case report and review of the literature. Clin Rheumatol 2005; 24:507.
  33. Saadoun D, Terrier B, Semoun O, et al. Hepatitis C virus-associated polyarteritis nodosa. Arthritis Care Res (Hoboken) 2011; 63:427.