Nephrotic syndrome refers to various symptoms that indicate the kidneys are not functioning properly. Doctors recognize that there is a link between hepatitis C infection and nephrotic syndrome.
People living with hepatitis C have an increased risk of developing kidney problems.
When damage occurs to the kidneys, they are unable to filter the blood as they should. As a result, a person may have excess levels of protein in their urine, an excess amount of blood fats, and low levels of protein in the blood. These are all signs of nephrotic syndrome.
Keep reading to learn more about the link between hepatitis C infection and nephrotic syndrome, including information on diagnosis and treatment for both conditions.
Nephrotic syndrome is a collection of symptoms that can appear when the kidneys are not functioning properly. It happens when damage occurs to the glomeruli in the kidneys.
The glomeruli are networks of small blood vessels or capillaries that filter water and waste products from the blood. After filtering occurs, extra fluid and waste pass into a collecting tube and become urine. Urine collects in the bladder and leaves the body through a person’s ureters.
The vessel membrane also prevents blood cells, protein, and other large molecules from entering the kidneys from the bloodstream.
However, if damage occurs to the glomeruli and they become inflamed, protein may enter the kidneys and filter into the urine.
Signs of nephrotic syndrome can include:
- proteinuria, an excess of protein in the urine
- hypoalbuminemia, where there are low levels of a protein called albumin in the blood
- hyperlipidemia, which refers to high levels of cholesterol and other fats in the blood
- edema, or swelling in parts of the body
A person may have no symptoms or not know they have nephrotic syndrome until it shows up in routine tests.
Blood tests may indicate low protein levels, high levels of creatinine, or high levels of fat. Creatinine is a protein that can indicate kidney damage. Urine tests can show whether protein is present in a person’s urine.
If a person develops symptoms, they may include:
People living with hepatitis C have an increased risk of developing kidney disease, and doctors recognize that there is a link between hepatitis C and nephrotic syndrome.
People with hepatitis C can develop kidney problems that can cause:
Hepatitis C may be a secondary cause of a person’s nephrotic syndrome rather than the primary cause. The secondary cause relates to diseases that affect the entire body, including the kidneys.
Nephropathy is a broad medical term referring to kidney disease. Doctors associate several nephropathies with hepatitis C, including:
- Mixed cryoglobulinemia: Doctors mostly associate this rare nephropathy with hepatitis C infection. It can cause abnormal proteins called cryoglobulins to appear in the blood. Cryoglobulins can thicken and clump together, restricting blood flow to the joints, muscles, and organs.
- Membranoproliferative glomerulonephritis (MPGN): In MPGN, an individual’s immune system begins to attack the healthy glomeruli, or filtering units, in the kidneys.
- Focal segmental glomerulosclerosis: This condition also affects the glomeruli and can lead to scarring of the structures. It is the
most commoncause of nephrotic syndrome in Black adults.
- Membranous nephropathy: Individuals with this condition have a buildup of protein in the part of the kidneys called the glomerular basement membrane. It is the
most commoncause of nephrotic syndrome in white adults.
A doctor will diagnose these conditions in the following ways.
Doctors typically begin by taking a medical history and asking about the symptoms a person is experiencing.
They may also perform a physical exam to look for enlarged, swollen organs or other signs. Depending on their findings, they may then order the following tests:
- Urine tests: Doctors might perform a series of tests to check for protein and assess if a person is losing too much protein through urine. These can include urine dipstick, 24-hour urine collection, or urine albumin-creatinine ratio tests.
- Blood tests: Doctors can take blood samples to check for protein, blood lipids or fats, and other components.
- Kidney biopsy: This test requires taking a small tissue sample from the kidneys. The laboratory examines the biopsy sample under a microscope to look for cell changes.
- Ultrasound: Doctors can use this form of imaging to check on the size and general appearance of the kidneys and blood vessels.
Doctors may also take a medical history and perform a physical exam during the diagnostic process for hepatitis C. They can diagnose hepatitis C using blood tests.
A screening blood test might look for antibodies to the hepatitis C virus. However, these tests may not be accurate immediately following infection. This is because the immune system takes time to make these antibodies.
If a person has a positive antibody test, they have had a hepatitis C infection at some point. However, it does not necessarily mean they have a current infection. Therefore, if someone has a positive test, a doctor may also order further tests to check for the amount or genotype of the hepatitis C virus in the person.
Additional tests might include a liver biopsy or liver ultrasounds.
Treatment options for these linked conditions are as follows.
There is currently no cure for nephrotic syndrome, but medications can help ease symptoms and limit further kidney damage. Treatment can vary depending on the symptoms, causes, and severity of the condition.
Medications doctors may use include:
ACE inhibitors and ARBs work by reducing blood pressure and protein loss.
Treating the underlying cause of this condition can help improve kidney function and reduce symptoms associated with kidney damage. If the cause is hepatitis C, people should receive medications to treat it. This is because nephrotic syndrome can lead to kidney failure or other complications in some cases.
If an individual has chronic hepatitis C, doctors typically use direct-acting antiviral medicines to treat the infection. These can include:
- daclatasvir (Daklinza)
- elbasvir (Zepatier)
- ledipasvir and sofosbuvir (Harvoni)
- ombitasvir, paritaprevir, ritonavir, and dasabuvir (Viekira Pak, Viekira XR)
- ribavirin (Virazole)
- peginterferon alfa-2a or b
An individual may require up to 6 months of treatment depending on the health of the liver and the genotype of the hepatitis C virus.
Hepatitis C is a viral blood infection that can eventually cause serious liver damage. It can also affect the kidneys and increase the risk of an individual developing nephrotic syndrome.
Nephrotic syndrome is an umbrella term for symptoms that appear when damage occurs to the kidneys. A person with nephrotic syndrome may have protein in the urine, low levels of protein in the blood, and high levels of cholesterol and other blood lipids. They may also experience swelling in parts of their body.
Doctors can typically cure hepatitis C with antiviral medications. There is currently no cure for nephrotic syndrome, but medications can ease symptoms and limit further kidney damage.