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World J Hepatol. Mar 27, 2022; 14(3): 516-524
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.516
Renal manifestations of hepatitis E among immunocompetent and solid organ transplant recipients
Karthik Kovvuru, Nicholas Carbajal, Abhinandan Reddy Pakanati, Charat Thongprayoon, Panupong Hansrivijit, Boonphiphop Boonpheng, Pattharawin Pattharanitima, Voravech Nissaisorakarn, Wisit Cheungpasitporn, Swetha R Kanduri
Karthik Kovvuru, Nicholas Carbajal, Swetha R Kanduri, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
Abhinandan Reddy Pakanati, Department of Medicine, The Kidney Clinic LLC, Snellville, GA 30078, United States
Charat Thongprayoon, Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
Panupong Hansrivijit, Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
Boonphiphop Boonpheng, Department of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States
Pattharawin Pattharanitima, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
Voravech Nissaisorakarn, Department of Internal Medicine, MetroWest Medical Center, Tufts University School of Medicine, Boston, MA 01760, United States
Wisit Cheungpasitporn, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Kovvuru K, Carbajal N, Pakanati AR, Thongprayoon C, Hansrivijit P, Boonpheng B, Pattharanitima P, Nissaisorakarn V and Kanduri SR contributed to acquisition of data, drafting the article; Cheungpasitporn W contributed to overall supervision and final approval.
Conflict-of-interest statement: The authors declared no potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wisit Cheungpasitporn, FACP, Associate Professor, Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. wcheungpasitporn@gmail.com
Received: June 25, 2021
Peer-review started: June 25, 2021
First decision: July 27, 2021
Revised: August 4, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: March 27, 2022
Processing time: 272 Days and 13 Hours
Abstract

Hepatitis E virus (HEV) infections are generally self-limited. Rare cases of hepatitis E induced fulminant liver failure requiring liver transplantation are reported in the literature. Even though HEV infection is generally encountered among developing countries, a recent uptrend is reported in developed countries. Consumption of unprocessed meat and zoonosis are considered to be the likely transmission modalities in developed countries. Renal involvement of HEV generally holds a benign and self-limited course. Although rare cases of cryoglobulinemia are reported in immunocompetent patients, glomerular manifestations of HEV infection are frequently encountered in immunocompromised and solid organ transplant recipients. The spectrum of renal manifestations of HEV infection include pre-renal failure, glomerular disorders, tubular and interstitial injury. Kidney biopsy is the gold standard diagnostic test that confirms the pattern of injury. Management predominantly includes conservative approach. Reduction of immunosuppressive medications and ribavirin (for 3-6 mo) is considered among patients with solid organ transplants. Here we review the clinical course, pathogenesis, renal manifestations, and management of HEV among immunocompetent and solid organ transplant recipients.

Keywords: Hepatitis E; Acute kidney injury; Glomerular disorders; Kidney biopsy; Solid organ transplant; Kidney transplant

Core Tip: Hepatitis E virus (HEV) infection is infrequently associated with significant mortality and morbidity. HEV infection is not only restricted to developing countries, but is also identified among developed nations and predominantly holds zoonotic transmission. Renal manifestations of HEV infection range from acute tubular necrosis to immune-mediated glomerular injury. Conservative approach is routinely employed in management of acute kidney injury from HEV. Ribavirin and reduction of immunosuppression are considered among patients with solid organ transplants as they are prone to develop chronic hepatitis E infection. Plasma exchange and pulse steroids are sometimes used in management of crescentic glomerular nephritis associated with HEV infection.