HCV cirrhotic patients treated with direct-acting antivirals: Detection of tubular dysfunction and resolution after viral clearance
Date
2021-02-04Author
Danjuma, Mohammed Ibn Mas’udAbouJabal, Bodoor
Naseralallah, Lina Mohammad Ahmad
Elzouki, Abdelnaser
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Bilotti et al's1 recent excellent report on the prevalence of tubular and glomerular dysfunction in patients with HCV infection on direct-acting antiviral (DAA) agents, and their evolution following HCV clearance adds to recent attempts at exploring the subclinical role of KIM-1 (among other markers of tubular dysfunction) as early biomarkers of tubular damage. Her report showed urinary KIM-1 thresholds (4.7 [3.4-11.3] vs 2.1 [1.0-3.4] ng/mg, P < .001) in patients with tubular injury compared to their normal counterparts. The median KIM-1 threshold for tubular dysfunction in healthy volunteers and across various morbidities within the general population ranged between 0.059 and 2.15 ng/L and 3.5 and 7.1 ng/L respectively.2, 3 The comparatively higher levels of urinary KIM-1 (corrected for creatinine excretion) reported by Bilotti et al is probably attributable to a combination of upregulation of KIM-1 excretion by HCV viral infection itself; additional effect of DAA’s (possibly other drugs such as Cisplatin, Carboplatin and Tenofovir2) and, as yet to be determined, factor(s) associated with polymorphisms of the KIM-1 receptor (Figure1).
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