Can the novel agents used to treat hepatitis C cause AKI?
Most of the novel agents used to treat Hep C now in the current
era are Sofosbuvir based. It has low rate of drug-drug interaction but kidney
excretes over 70% of it’s major metabolite. This metabolite know as GS-331007
increases by ten fold in patients with renal dysfunction.
To my knowledge, no initial trials had any cases of AKI
reported with this agent. Based on some recent trials using this agent, AKI
might happen in 1-15% of patients treated with this agent. Higher incidences were seen ( 45%) in liver
transplant patients getting this agent.
When?- 9-22 weeks of treatment.
Risk factors:- CKD, NSAID use, other nephrotoxic agent, DMII and ascites
Risk factors:- CKD, NSAID use, other nephrotoxic agent, DMII and ascites
Pathology:- what is the mechanism? There are only 4
published cases of kidney biopsy findings. We had published the first case of this in
2016 that showed AIN. Subsequently,
3 other cases with AIN have been published and in one case ATN was also reported.
It appears that the most likely mechanism is interstitial disease. In 2 of the
4 cases, 8 weeks was the time frame of injury, in remaining was 14 and 22 weeks
of injury. It seems to be reversible in most cases.
This is an interesting trend to watch. As we see less and
less of Hep C induced renal disease, it is more likely we may see more treatment
induced renal disease now.
A
recent review of this topic is a good read.
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