Effect of interferon free antiviral therapy on glomerular and tubular kidney involvement in HCV child-A cirrhosis

Background: Hepatitis C virus (HCV) infection is associated with an increased risk of renal disease. The correlation between HCV and glomerular damage is well recognized, but limited data are available on HCV-mediated tubular damage. Recently, several novel direct antiviral agents (DAAs) have been approved for HCV treat- ment, but the effects of HCV clearance on renal involvement (RI) has not been fully characterized. Aim: The aim of this study was to evaluate the effect of viral eradication, by means of DAAs, on renal glomerular (GI) and tubular involvement (TI) in pts with HCV-related cirrhosis. Materials and methods: 94 CPA cirrhotic pts treated with DAAs were consecutively enrolled. Estimated glomerular filtration rate (e-GFR) assessed by CKD-EPI equation, urinary albumin- to-creatinine ratio (ACR), urinary 1-microglobulin-to-creatinine ratio (1MCR) and sodium fractional excretion (FeNa) were eval- uated before starting therapy (T0) and six months after treatment withdrawal (FU6). GI was defined as ACR > 30 mg/g, TI was defined as 1MCR > 14 mg/g and/or FeNa > 1%. Results: RI (glomerular and/or tubular) occurred in 39 pts (41.5%). GI was found in 19 pts (20.2%), 6 of them (31.6%) had dia- betes. TI was detected in 30 pts (31.9%). Pts with RI showed lower e-GFR values than pts without RI (95.2 ± 15.2 mL/min/1.73 m2 vs. 85.1 ± 5.8 mL/min/1.73 m2 , p = 0.07). In diabetic pts with GI, ACR did not change after treatment (316.2 ± 406.7 mg/g vs. 321.3 ± 416.2 mg/g, p = 0.92), while a significant reduction of ACR (73.5 ± 138.5 mg/g vs. 19.9 ± 12.3 mg/g, p = 0.019) occurred in non- diabetic HCV cirrhotic pts and GI resolved in 11/13 (84.6%) pts without diabetes. The proportion of pts with TI decreased sig- nificantly after DAAs treatment, since in 14/25 (56%) patients TI recovered. Conclusions: Our study confirms a strong relationship between HCV and GI and underlines significant occurrence of TI. In HCV cirrhotic pts with diabetes the GI seems to be mainly driven by the metabolic disorder rather than by HCV infection itself. This is the first report demonstrating a significant improvement of either non-diabetic glomerular, either tubular HCV-induced damage after HCV clearance by DAAs therapy, emphasizing the importance of antiviral treatment.