Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Mar 14, 2010; 16(10): 1226-1231
Published online Mar 14, 2010. doi: 10.3748/wjg.v16.i10.1226
Microalbuminuria in hepatitis C-genotype 4: Effect of pegylated interferon and ribavirin
Moutaz Derbala, Fatma M Shebl, Awad Rashid, Aliaa Amer, Abdulbari Bener
Moutaz Derbala, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, 00974, State of Qatar; Department of Medicine, Weill Cornell Medical College in Qatar, Doha, 00974, State of Qatar
Fatma M Shebl, Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, United States; Epidemiology Branch, National Liver Institute, Shibin Elkom, Menoufia, 32511, Egypt
Awad Rashid, Department of Nephrology, Hamad Medical Corporation, Doha, 00974, State of Qatar
Aliaa Amer, Department of Laboratory Medicine and Histopathology, Hematology Section, Hamad Medical Corporation, Doha, 00974, State of Qatar
Abdulbari Bener, Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, 00974, State of Qatar
Author contributions: All authors have actively participated in data collection and patients’ follow-up; Shebl FM and Bener A performed the statistical analysis; the principal investigator Derbala M wrote the manuscript; all co-authors reviewed the manuscript.
Correspondence to: Moutaz Derbala, MD, PhD, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, PO Box 3050, Doha, 00974, State of Qatar. moutazderbala@hotmail.com
Telephone: +974-5355671 Fax: +974-4392279
Received: October 2, 2009
Revised: November 3, 2009
Accepted: November 10, 2009
Published online: March 14, 2010
Abstract

AIM: To study the relation between hepatitis C virus (HCV) genotype 4 and microalbuminuria and renal impairment in relation to hepatic histology, and viremia in the absence of cryoglobulinemia, and to examine the effect of treatment on microalbuminuria.

METHODS: Three hundred subjects, including 233 HCV genotype-4 infected patients, were tested for cryoglobulinemia, microalbuminuria, albumin creatinine ratio (ACR), urea, creatinine, and estimated glomerular filtration rate (eGFR). The parameters were measured again in the HCV patients after 48 wk of treatment with pegylated interferon and ribavirin.

RESULTS: Significantly higher levels of microalbuminuria were detected in HCV-positive patients compared to HCV-negative controls (median 9.5 vs 5.9, respectively, Kruskal-Wallis P = 0.017). Log microalbuminuria was significantly correlated with hepatic inflammation (r = 0.13, P = 0.036) and fibrosis (r = 0.12, P = 0.061), but not with viral load (r = -0.03, P = 0.610), or alanine transaminase (r = -0.03, P = 0.617). Diabetes mellitus neither significantly moderated (χ2 = 0.13, P = 0.720), nor mediated (Sobel test P = 0.49) the HCV effect. HCV status was significantly associated with log microalbuminuria (χ2 = 4.97, P = 0.026), adjusting for age, gender, diabetes, cryoglobulinemia, urea and creatinine. A positive HCV status was not significantly associated with low eGFR (< 60 mL/min every 1.73 m2) [odds ratio (OR): 0.5, 95% confidence interval (CI): 0.2-1.4], nor with high ACR (OR: 1.7, 95% CI: 0.7-4.1). End-of-treatment response (ETR) was achieved in 51.9% of patients. Individuals with ETR had significantly lower microalbuminuria post-treatment (χ2 = 8.19, P = 0.004).

CONCLUSION: HCV affected the development of microalbuminuria independent of diabetes or cryoglobulinemia. Combination therapy of pegylated interferon-ribavirin had a positive effect in reducing microalbuminuria.

Keywords: Hepatitis C virus, Genotype, Kidney diseases, Albuminuria, Proteinuria, Peginterferon α-2a, Ribavirin