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PREVALENCE OF HEPATITIS C VIRUS INFECTION IN PATIENTS WITH RENAL DISEASE

Project Topic: Prevalence of Hepatitis C Virus (HCV) Infection in Patients with Renal Disease


ABSTRACT

 Acute renal failure is an abrupt decrease in kidney function that leads to accumulation of nitrogenous wastes such as blood urea nitrogen and creatinine. This can be caused by infectious agents. Thus, the objective of the study was to investigate the prevalence of HCV in renal failure patients. The study population comprise of patients with renal failure. Information on demographic features and social life habits were abstracted from the patients and their hospital folders. Blood was collected via venipuncture and serum extracted. The serum was used for anti-HCV antibodies test using 3rd generation anti-HCV kit. Alanine amino transferase, urea and creatinine were estimated. A total of 175 renal patients were analyzed of which, 20 (11.4%) were positive for anti-HCV antibodies. The males had higher HCV positivity than the females (15 vs 5) [8.6% vs 2.8%] while the patients of 41 years and above were 12 (6.8%). Only diabetes was a co-morbid factor, while those on dialysis had HCV positivity of 11 (6.3%) which is statistically significant (P < 0.05). The risk factors for the transmission of HCV were receipt of blood transfusion and dialysis. The patients with Chronic Renal Failure (CRF) had higher anti-HCV antibodies when compared with those with acute renal failure and nephritis. The biochemical markers estimated show that the patients with elevated ALT level had HCV positivity (mean 28.6+4.9 to 49.0+10.+ IU/L). Anti-HCV antibodies were more in patients with elevated urea (15) [8.6%] and creatinine (14) [8.0%] levels, mean values 27.7+19.3 mmol/L and 587.3+265.9 mmol/L respectively. The high prevalence of HCV in renal failure patients in this study is of concern and HCV infection may antagonize the treatment of the renal failure patient thereby leading to high mortality. Screening for HCV antibodies is hereby advocated among the population.

 CHAPTER ONE:    INTRODUCTION

Hepatitis C virus (HCV) is a global health problem, with an estimated 3% of the world’s population currently infected; and approximately 170 million persons at risk of Fulminant Hepatitis (FH) disease (WHO, 2000); although very rarely HCV causes Fulminant Hepatitis (Farci et al, 2000).

The hepatitis C virus belongs to the flaviviridae family of viruses, and is spread primarily through direct contact with the blood or bodily fluids of infected individuals (Forns and Bukh, 1999). It is a leading cause of chronic liver disease including liver cirrhosis and end stage liver disease. Primary exposure to the hepatitis C virus leads to an acute infection which is usually relatively mild. Only 20-30% of infected individuals develop clinically evident acute hepatitis C in their attempt to resolve the infection (Alter et al, 1997). Symptoms include jaundice, fatigue, abdominal pain and intermittent nausea (CDC, 2000). More significant, however, are the 70 – 80% of acute HCV infections that do not resolve, but lead to persistent viral infections (Alter et al, 1997). The sequelae of chronic HCV infections include cirrhosis of the liver as well as hepatocellular carcinoma, both of which carry significant socioeconomic costs and public health consequences. In developed countries, HCV – related liver disease is currently the leading cause of liver transplantation (MMWR, 1998).

Eventhough hepatitis C virus (HCV) infection leads to chronic liver disease; it also leads to extrahepatic manifestations (Cacoub et al, 2002). These include mixed cryoglobulinaemia, lymphoproliferative disorders and renal disease (Kamar et al, 2006), due to production of auto antibodies.

Renal disease is any disease that affects the normal function of the kidneys which results to decrease in the glomerular filtration rate, abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium and phosphate; hematuria (blood in urine) and (in the long term) anaemia (NIH, 2007).

An estimated 4 million Americans have been exposed to the hepatitis C virus (HCV), representing approximately 2% of the US population (Alter et al, 1998). The prevalence of HCV seropositivity among case series of patients with membrano proliferative glomerulonephiritis (MPGN) is approximately 20% (Fabrizi et al, 1998; Gumber et al, 1995; Johnson et al, 1993; Yamabe et al, 1995). A previous study (Garcia-Valdecasas et al, 1993) showed a prevalence of HCV antibodies of 18.5% in patients with chronic renal failure before reaching End Stage Renal Disease (ESRD). Furthermore, a prevalence of 13.2% HCV positivity was found in 53 MPGN patients by Prakash et al (2004).

In Nigeria, the prevalence and risk factors for acquiring HCV infection among patients with renal disease is not well elucidated. Therefore this study was designed to redress these issues, educate the persons with such infection and elucidate ways to reducing the burden of life.

AIMS:

  1. To determine the prevalence of HCV infection in patients with renal disease.
  2. To determine the patterns of variation in markers of kidney functions

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Project Topic: Prevalence of Hepatitis C Virus (HCV)  Infection in Patients with Renal Disease

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