Sofosbuvir and ledipasvir decreased nephrotic syndrome caused by IgA nephropathy with a membranoproliferative pattern of injury in hepatitis C virus-induced cirrhosis: a case report.

Background: Immunoglobulin (Ig) A nephropathy (IgAN) with a membranoproliferative pattern of injury that manifests as nephrotic syndrome (NS) is rarely reported in hepatitis C virus (HCV)-induced cirrhosis. It is not known whether eradication of HCV by direct-acting antiviral (DAA) drugs can lead to remission of proteinuria and improve the long-term prognosis.

Case Description: We report the case of a 52-year-old woman with HCV cirrhosis for 10 years. She had undergone splenectomy and cholecystectomy due to complications of liver cirrhosis. The patient presented with NS and was diagnosed by kidney biopsy with IgAN with a membranoproliferative pattern of injury. Twelve-week sofosbuvir and ledipasvir therapy successfully eradicated HCV in this decompensated cirrhosis patient and resulted in partial remission of IgAN. The patient stayed in partial remission for 4 years and had her first relapse with deterioration of portal hypertension and suspected hepatic carcinoma despite a sustained HCV virologic response. We consider the IgAN in this case to be secondary to liver cirrhosis and HCV infection rather than a primary nephropathy. DAA drugs which have no direct reno-protective effect resulted in partial remission of IgAN because they eradicated HCV and improved the liver disorder.

Conclusions: Although relapse of IgAN could occur when liver cirrhosis deteriorates, DAA treatment may be considered an alternative for similar patients.