ПОРАЖЕНИЕ ПОЧЕК И ХРОНИЧЕСКИЙ ВИРУСНЫЙ ГЕПАТИТ С
Аннотация
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.
Об авторах
В. А. Добронравов
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии
197022 Санкт-Петербург, ул. Л. Толстого 17, НИИ Нефрологии СПбГМУ им. акад. И.П. Павлова; тел.: (812)-234-66-56
Н. В. Дунаева
Российская академия медицинских наук, Санкт-Петербург
Россия
Научно-исследовательский институт гриппа
Россия
Научно-исследовательский институт гриппа
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Добронравов В.А., Дунаева Н.В. ПОРАЖЕНИЕ ПОЧЕК И ХРОНИЧЕСКИЙ ВИРУСНЫЙ ГЕПАТИТ С. Нефрология. 2008;12(4):9-19. https://doi.org/10.24884/1561-6274-2008-12-4-9-19
For citation:
Dobronravov V.A., Dunaeva N.V. RENAL DAMAGE AND CHRONIC HEPATITIS C VIRUS. Nephrology (Saint-Petersburg). 2008;12(4):9-19. (In Russ.) https://doi.org/10.24884/1561-6274-2008-12-4-9-19
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