INTRODUCTION AND AIMS: Fibrillary glomerulonephritis (FGN) is a rare glomerular pathology in native renal biopsies. Hepatitis C viral (HCV) infection is an infrequent associated condition but relationship between HCV and FGN is still inconclusive. From literature review, most of patients with HCV associated FGN had an unfavorable renal outcome, however there is no report after an introduction of novel direct acting antiviral therapy (DAA).
METHODS: We here reported two male patients with HCV associated FGN whose age were 33 and 36 years, respectively.
RESULTS: Both patients had high HCV RNA viral load (16,260,240 and 1,241,013 IU/ml) and evidence of cirrhosis at diagnosis. The first patient received cyclophosphamide and steroid for 3 months but did not respond. At diagnosis, serum creatinine of both cases were 1.5 and 1.7 mg/dl while proteinuria were 3.6 and 7.6 g/gCr, respectively. Renal histopathology showed mesangial proliferation with increase in matrix and electron microscopy confirmed deposition of non-branching fibrils (18-28 nm in diameter). Both of them achieved sustained virological response after a 3-month course of sofosbuvir, daclatasvir and ribavirin. The first patient also got cyclophosphamide for 3 months followed by azathioprine. His serum creatinine decreased to 1.0 mg/dl and proteinuria was 1.8 g/gCr after follow up period of 16 months. The second patient did not received immunosuppressive agent. After treatment for 6 months, his blood pressure resumed normal. His serum creatinine was stable at 1.6 mg/dl and proteinuria was 1.5 g/gCr.
CONCLUSIONS: In consequence of satisfactory renal outcome after successful eradication of HCV, our study supported a relationship between FGN and hepatitis C viral infection. DAA is a promising treatment for HCV associated FGN.
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