Hepatitis C Virus

Hepatitis C Virus

Anthony Chang, MD

Periodic acid-Schiff reveals increased cellularity that highlights the lobularity of the glomerular tufts, which is characteristic of a membranoproliferative injury pattern.

Many double contours of the GBMs image are noted in this patient with cryoglobulins (not shown) and hepatitis C infection.



  • Hepatitis C virus (HCV)


  • Wide spectrum of immune complex-mediated glomerular injuries in association with HCV infection


Infectious Agents

  • HCV

    • RNA virus: Single-stranded, positive sense

    • Infects hepatocytes and B lymphocytes

    • Blood-to-blood with rare sexual transmission

  • Unknown pathogenic mechanism of kidney diseases

    • Possible contributing factors include

      • Circulating immune complexes of HCV antigen and antibodies

      • Cryoglobulins



  • Incidence

    • Over 200 million people worldwide are infected

  • Age

    • Infected children have high rate of spontaneous resolution

  • Gender

    • Young females may spontaneously resolve and are less likely than males to develop cirrhosis or hepatocellular carcinoma (HCC)


  • Proteinuria

  • Hematuria

Laboratory Tests

  • Serologic test

    • HCV antibodies

  • PCR

    • HCV viral load

  • HCV genotyping

Natural History

  • 17-55% of HCV-infected patients progress to cirrhosis

  • 2-23% develop HCC


  • Drugs

    • Ribavirin

    • Pegylated interferon-α

  • Kidney &/or liver transplantation


  • HCV genotype 2A and 3A have high cure rates


Histologic Features

  • Membranoproliferative glomerulonephritis (MPGN)

    • Accentuation of glomerular tuft/lobules

    • Duplication of glomerular basement membranes or “tram track”

  • Cryoglobulinemic GN

    • Endocapillary hypercellularity

    • “Wire loop” or hyaline “thrombi” deposits

      • PAS positive

  • Membranous glomerulonephritis (MGN)

    • Thickened glomerular basement membranes with subepithelial “spike” formation

  • Fibrillary GN

    • Mesangial expansion

  • Immunotactoid glomerulopathy

    • Mesangial expansion

  • IgA nephropathy

    • Variable mesangial hypercellularity



  • MPGN

    • IgG and C3 granular staining of glomerular capillary walls and mesangial regions

  • Cryoglobulinemic GN

    • IgG &/or IgM staining along glomerular capillaries and mesangial areas

    • Polyclonal or rare monoclonal light chain staining

  • MGN

    • IgG granular staining of the capillary walls and some mesangial areas

  • Fibrillary GN

    • IgG granular staining of capillary walls and mesangial areas

    • Polyclonal staining for kappa and lambda light chains

  • Immunotactoid glomerulopathy

    • IgG granular staining of mesangial areas and capillary walls

    • Monoclonal light chain staining is typical

  • IgA nephropathy

    • IgA granular mesangial staining with variable involvement of capillary walls

Electron Microscopy

  • MPGN

    • Subendothelial & mesangial electron-dense deposits

    • Duplication of GBM

  • Cryoglobulinemic GN

    • Subendothelial & mesangial electron-dense deposits

    • Substructural organization of deposits may be present

  • MGN

    • Subepithelial & mesangial electron-dense deposits

  • Fibrillary GN

    • Randomly arranged fibrils ˜ 20 nm in diameter

  • Immunotactoid glomerulopathy

    • Microtubules with hollow centers arranged in parallel arrays measuring > 30 nm in diameter

  • IgA nephropathy

    • Mesangial electron-dense deposits with variable subendothelial or subepithelial involvement


HCV-associated Focal Segmental Glomerulosclerosis

  • Segmental sclerosis of glomeruli

  • Absence of immune complex deposition

Hepatitis B Virus-associated Immune Complex Disease

  • Pathologically identical to HCV-associated immune complex disease

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatitis C Virus
Premium Wordpress Themes by UFO Themes
%d bloggers like this: