Improvement of Proteinuria due to Combination Therapy with Daclatasvir and Asunaprevir in Hepatitis C Virus-associated Renal Disease without Cryoglobulinemia

Satoshi Takakusagi; Ken Sato; Yuhei Suzuki; Yuichi Yamazaki; Takashi Kosone; Satoru Kakizaki; Motoyasu Kusano; Hitoshi Takagi

doi:10.2169/internalmedicine.9624-17

CASE REPORTS

Improvement of Proteinuria due to Combination Therapy with Daclatasvir and Asunaprevir in Hepatitis C Virus-associated Renal Disease without Cryoglobulinemia

Satoshi Takakusagi, Ken Sato, Yuhei Suzuki, Yuichi Yamazaki, Takashi Kosone, Satoru Kakizaki, Motoyasu Kusano, Hitoshi Takagi

Author information

Satoshi Takakusagi
Department of Gastroenterology and Hepatology, Kusunoki Hospital, Japan
Ken Sato
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
Yuhei Suzuki
Department of Gastroenterology and Hepatology, Kusunoki Hospital, Japan
Yuichi Yamazaki
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
Takashi Kosone
Department of Gastroenterology and Hepatology, Kusunoki Hospital, Japan
Satoru Kakizaki
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
Motoyasu Kusano
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Japan
Hitoshi Takagi
Department of Gastroenterology and Hepatology, Kusunoki Hospital, Japan

Keywords: cryoglobulinemia, direct-acting antiviral agent, extrahepatic manifestation, hepatitis C virus, renal disease

JOURNAL OPEN ACCESS

2018 Volume 57 Issue 15 Pages 2189-2195

DOI https://doi.org/10.2169/internalmedicine.9624-17

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Abstract

We herein report a unique case of hepatitis C virus (HCV)-associated renal disease without cryoglobulinemia that showed proteinuria, hypoproteinemia, ascites, and edema. Due to combination therapy with daclatasvir and asunaprevir, the patient achieved sustained virological response at week 24 of the therapy. Furthermore, the therapy caused marked amelioration of her proteinuria, ascites, edema, and hypoalbuminemia, and finally improved her estimated glomerular filtration rate. There were no adverse events, and the combination therapy was well-tolerated. We recommend that HCV eradication with antiviral therapy using direct-acting antiviral agents be attempted first for all renal disease with HCV infection, regardless of cryoglobulinemia, considering the existence of resistance-associated variants.

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