Hepatice C em portadores de insuficiência renal crônica em tratamento hemodialítico: estudo clínico, epidemiológico e laboratorial

Abstract

There has been, lately, an increasing interest in studying the behavior of the hepatitis C infection in patients with terminal renal failure. In the present study, the following aspects of the disease were evaluated: 1) the prevalence of hepatitis C in patients with renal failure; 2) clinical and epidemiological aspects of the infection; 3) the detection of HCV-RNA in plasma and liver tissue and the identification of the genotypes; 4) ultrasonographic alterations of the liver; and, 5) histological alterations in fragments of liver obtained by needle biopsy. This is a study of coorte comparing patients with chronic renal failure (Group I) with blood donor candidates (Group II). All tested positive for hepatitis C infection byan ELISA technique. 76 patients in Group I and 77 volunteers in Group II have been selected for the study. The RNA for HCV was sought in liver and plasma using the nested polymerase chain reaction-reverse transcriptase (RT-PCR) and genomic sequencing. Genotyping was performed using the restriction fragment length polymorphism (RFLP) technique and genomic sequencing. All patients underwent liver biopsy. The middle ages for Groups I and II were 43 and 40, respectively. Elevated serum levels of ALT were described in 44.7% of Group I patients and 63.6% of Group II individuals (p=0.019). Serum markers of cured hepatitis B infection and the use of hepatotoxic drugs were moreprevalent in Group I and alcohol abuse in Group II. On ultrasound a normal liver texture was noticed in 86.8% and 80.5% in Groups I and II, respectively (p=0.290). Hepatits C viral RNA was identified in the sera of 72 patients (94.7%) in Group I and in 65 volunteers in Group II (p=0.022). The genotype 1 was the most common genotype found in both groups. Genotype 3 was more prevalent in Group II (p=0.001), and genotype 2 was described in 8 patients in Group I (10.5%) and in one individual of Group II (1.3%)(p=0.016). In six out of 96 129 patients (6.3%) the RT-PCR was found to be negative in sera and positive In the liver. Liver histology, classified according to METAVIR, showed no statistical difference in inflammation and fibrosis, when groups I and II were compared;liver steatosis and siderosis, though, were more frequently reported in Group I. Summing up, in the present study, genotype 1 of hepatitis C predominated, followed by genotype 2 in patients with chronic renal failure. There was no ignificant difference in viral load for both groups. Siderosis (in Kuppfer cells and in hepatocytes) was more frequently observed in Group I and this may have increased the frequency of liver fibrosis in Group I. Severe complications of liver biopsy were observed only in patients with renal failure.