Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.516
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
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.
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.