Hep C Discussion Forum

This is old, but is applicable, in regard to "basic info" about "extrahepatic manifestations" and the association between having HCV and developing diabetes or chronic kidney disease. 

(Excerpt) from "Renal and Urology News":

Annette Bruchfeld, MD, PhD

August 15, 2016

FEATURE

Hepatitis C in CKD: Challenges and Opportunities

[Editor's note: This review and commentary includes study data presented at the 53^rd Congress of the European Renal Association-European Dialysis & Transplant Association (ERA-EDTA 2016) in Vienna, Austria, May 21-24. 2016, and reflects discussions that took place at the congress.]

Infection with the hepatitis C virus (HCV) affects more than 170 million people worldwide. After acute infection, 80% to 85% of individuals do not clear the virus and progress to chronic infection and its associated complications.¹ The risk of liver-related complications such as cirrhosis and hepatocellular carcinoma is well known, but it has become apparent that HCV is also associated with extra-hepatic complications, including chronic kidney disease (CKD).

... HCV infection increases ESRD risk among patients with diabetes ...

HCV and chronic kidney disease

According to a recent systematic review and meta-analysis, individuals who are seropositive for anti-HCV antibodies (HCV+) have a significant 23% greater relative risk of having and/or developing CKD compared with uninfected individuals.² At the 53^rd Congress of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) in Vienna, I advised delegates that chronic HCV infection should be seen as a metabolic disease that causes chronic systemic inflammation through direct viral effects on the vasculature and indirect effects via the immune system and the liver. The result is a pro-inflammatory state that increases the risk of atherosclerosis, cardiovascular disease, the metabolic syndrome, and diabetes.³These are known risk factors for CKD in the general population, but a large cohort study in Taiwan concluded that there is a significant and independent association between HCV and CKD in the absence of traditional CKD risk factors.⁴

It is now well recognized that HCV is associated with glomerular disease, most commonly membranoproliferative glomerulonephritis with or without cryoglobulinemia. Other reported lesions include membranous nephropathy, focal segmental glomerulosclerosis, fibrillary or immunotactoid glomerulopathies, and thrombotic microangiopathy.⁵ HCV is thought to cause renal injury through the action of cryoglobulins, HCV-antibody immune complexes, and direct cytopathic effects, including endotheliitis, mesangial inflammation and podocyte injury.⁶ 

Worldwide, diabetes mellitus is the most common cause of end-stage renal disease (ESRD),⁷and HCV adds to the risk in these patients. In a study, the risk of ESRD was 44% greater in patients with both diabetes and HCV patients than in those without HCV (HCV - ). The risk was 2.0 and 1.8 times as great for patients younger than 50 years and those infected within 4 years of their diabetes diagnosis, respectively.⁸ The presence of diabetes may therefore be a strong indication for antiviral treatment. A study from Taiwan demonstrated that patients treated for HCV infection had a significant 84% reduction in the risk of ESRD, a significant 47% reduction in the risk of ischemic stroke, and a non-significant 36% reduction in the risk of acute coronary syndromes.^{9 ...}

See also:  https://www.hcvguidelines.org/unique-populations/renal-impairment - Treatment of renal patients, where the AASLD guidelines states that HCV is independently associated with the development of CKD, and that worsening of CKD is associated with having HCV.

And, as well, of course see: (from bottom) the post/link Tig originally started this thread with (http://hcvadvocate.org/hepatitis/factsheets_pdf/extrahepatic.pdf) for more  extensive listings of "Extrahepatic Manifestations of HCV".