nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2008-12-4-9-19nefr-1127Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEПОРАЖЕНИЕ ПОЧЕК И ХРОНИЧЕСКИЙ ВИРУСНЫЙ ГЕПАТИТ СRENAL DAMAGE AND CHRONIC HEPATITIS C VIRUSДобронравовВ. А.DobronravovV. A.

Научно-исследовательский институт нефрологии

197022 Санкт-Петербург, ул. Л. Толстого 17, НИИ Нефрологии СПбГМУ им. акад. И.П. Павлова; тел.: (812)-234-66-56

vd1704@yandex.ruДунаеваН. В.DunaevaN. V.

Научно-исследовательский институт гриппа

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian FederationРоссийская академия медицинских наук, Санкт-ПетербургRussian Federation200810042008124919Copyright © Добронравов В.А., Дунаева Н.В., 20082008Добронравов В.А., Дунаева Н.В.Dobronravov V.A., Dunaeva N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1127

С момента открытия HCV стала очевидной определенная взаимосвязь между персистированием хронического вирусного гепатита С (ХГС) и поражением почек, которое относится к одному из наиболее значимых системных клинических проявлений течения ХГС и имеет существенное значение для клинической нефрологической практики. Так, было показано явное преобладание антител к HCV у лиц с патологией почек по сравнению с донорами крови в регионах как с высокой, так и с низкой общей распространённостью HCV, а также у лиц с острыми и хроническими нефропатиями после трансплантации почек. Кроме того, у пациентов с ХГС значительно чаще имеют место реакции отторжения почечного трансплантата, развитие мембранознопролиферативного гломерулонефрита (ГН) и мембранозной нефропатии de novo. Представлены наблюдения о большей распространённости и гломерулярных и тубулоинтерстициальных повреждений у пациентов HCV-ассоциированными формами гломерулопатий. Клинически у пациентов с HCV, достоверно чаще выявляют такие лабораторные маркеры поражения проксимальных отделов нефрона как микроальбуминурия и значимая протеинурия. Явную ассоциацию хронической HCV-инфекции с развитием гломерулопатий подтверждают и другие прижизненные и аутопсийные морфологические исследования, указывающие на высокую распространенность поражений клубочков в этой популяции пациентов, достигающую 55-71%. Наконец, связь между ХГС и поражением почек также подтверждается и наблюдениями о положительной динамике почечных симптомов на фоне успешной противовирусной терапии. Вместе с тем, анализ исследований и личный опыт авторов статьи свидетельствуют о явной клинической и морфологической неоднородности HCV-ассоцированного поражения почек, обусловленных разными механизмами, отдельные клинико-патогенетическиe варианты которого рассматриваются в настоящем сообщении.

From the moment of the discovery of HCV the certain interconnection between persisting chronic hepatitis C virus (HCV) and renal damage, which is one of the most meaningful clinical manifestations of HCV and of a great importance for clinical nephrological practice, became obvious. So, was shown the clear prevalence of HCV antibodies in patients with renal pathology in comparison with blood donors in regions with high, as well as low total spread of HCV, and also in patients with acute and chronic nephropathies after renal transplantation. Besides that, in patients with HCV transplantation failure, the development of membranosous proliferative glomerulonephritis (GN) and membranosous nephropathies de novo take place more often. The higher spread of glomerular as well as tubolointerstinal damages in patients with HCV associated forms of glomerulopathies is shown. Clinically in patients with HCV, reliably more often such laboratory markers of the proximal part of nephron damage as microalbuminuria and significant proteinuria are revealed. The obvious association of chronic HCV infection with the development of glomerulopathies is also supported by lifetime and autopsy morphological investigations, pointing on the high extend of glomerular damage in such population of patients, reaching up to 55-71 %. And finally, the connection between HCV and renal damage is also supported by the observation of positive dynamics of renal symptoms with the use of successful antivirus therapy. With that, the analysis ofthe scientific reports and personal experience of the authors of the article, give evidence of an obvious clinical and morphological significance of heterogeneity of HCV associated renal damage, depending on various mechanisms, separate clinical-pathogenic variants of which are discussed in present article.

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The authors declare that there are no conflicts of interest present.