Frequency of Renal Diseases in Patients with Hepatitis C Virus

Submitted By: Supervisor:

Irfan Hussain Dr. Imtiaz Mehmood Tahir

BS(Hons) MLT, Roll No:15108 B.Sc MLT, M. Phil Biochemistry

GCU Faisalabad PhD Biochemistry

DEPARTMENT OF ALLIED HEALTH

PROFESSIONALS GVERNMENT COLLEGE
UNIVERSITY FAISALABAFD.
2013-2017

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 Approval Sheet

The student Irfan Hussain GCUF Roll No.15108, Registration No 2013-GCUF-S00108, given
the study on “Frequency of renal diseases in Hepatitis C Virus” for the study report submitted in
the partial fulfillment of requirement for the degree of BS (Hons) Medical Laboratory
Technology to the Government College University Faisalabad. We gone through this dissertation
and found no correction required.

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 Dedication

Dedicated to my Parents, Teachers and Friends for their love and support who always
have been encourage me throughout my studies and life.

Irfan Hussain Baloch

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 CERTIFICATE

It is hereby certified that Mr. Irfan Hussain, Roll No. 15108 of BS (Hons) Medical
Laboratory Technology has completed this study “Frequency of renal diseases in Hepatitis C
Virus at Liver Center and Chiniot Hospital Faisalabad” successfully as a requirement for
examination under our supervision. He is found devoted to his work. We wish his success in his
life.

Supervisor Co-Supervisor Member

Dr.Imtiaz Mehmood Tahir
B.Sc (MLT), M.Phil
PhD Biochemistry

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 ACKNOWLEDGEMENT

All my praises to Allah Almighty who is most Beneficial and most Merciful, who gave me
knowledge, power and health to write this work. I shall pay my tributes and thanks to my
Supervisors Dr.Imtiaz Mehmood Tahir and. I am also thankful to my teachers who guided me
a lot in my research. It is an honor for me to work with all these persons. Their encouragement,
guidance and support enabled me to develop an understanding for this work. I am also thankful
to the Pathology department of Liver Center and Chiniot Hospital Faisalabad, who also
play their role in this project. At the end, I am also very much thankful to my parents, my fellow
Mr. Majid Imran Shahid and Mr. Sohail Akbar for their support and encouragement during
all my education.

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 ABSTRACT

BACKGROUND: A few examinations from various parts of the world have discovered that the
occurrence of renal sicknesses related with HCV is high. Accordingly, it is critical to recognize
the size of this issue in HCV patients.

OBJECTIVE: The goal of the present examination was to decide the recurrence of renal
ailments in patients with HCV.

MATERIAL AND METHODS: The investigation configuration was observational clear that
did not include any moral issues. The patients which were satisfying the criteria were 99. Kidney
sicknesses were affirmed by performing Urea and Creatinine.

RESULTS: The results indicated that Out of 99 patients 69(69.7%) were male and 30(30.3%)
were female. Urea and Creatinine was positive in 63(63.7%) and negative in 36(36.3%).

CONCLUSION: It is concluded that the prevalence of renal diseases in HCV patients is high.

Key Words: Hepatitis C Virus, Blood Urea, Creatinine.

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 Table of Contents

Introduction:
 Hepatitis
 Anatomy and physiology of liver
 Epidemiology of liver
 Features of Hepatitis Viruses
 Introduction to Hepatitis C Virus
 Transmission
 Signs and symptoms
 Pathophysiology of Hepatitis C
 Diagnosis
 Extrahepatic manifestation of HCV
 Renal diseases associated with HCV
 Pathophysiology of renal diseases associated
with HCV
 Treatment
 Prevention

Review of Literature
 Case 1
 Case 2
 Case 3
 Case 4
 Case 5

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Material and Method
 Study Population
 Clinical setting
 Study Duration
 Study Design
 Sample size and sampling
 Technique
 Inclusion criteria
 Data Collection Instrument
 Operational definitions
 Hepatitis C
 Renal Diseases
 Urea
 Serum Creatinine
 Methodology
 Urea
 Reagents
 Procedure
 Creatinine
 Statistical Analysis
 Ethical issues

RESULTS:
DISCUSSION:
Conclusion
Limitations
REFERENCES

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List of Abbreviations

Abriviation Discription
ELISA ELISA Enzyme linked immunosorbent assay
PCR Polymerase Chain Reaction
HAV Hepatitis A Virus
HBV Hepatitis B Virus

HCV Hepatitis C Virus

HDV Hepatitis D Virus
HIV Human immunodeficiency virus
GN Glomerular nephritis
CKD Chronic kidney disease

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 INTRODUCTION
Hepatitis:
Hepatitis is a therapeutic condition characterized by the irritation of the liver and described by
the nearness of incendiary cells in the tissue of the organ. Hepatitis may happen with restricted or
no manifestations, yet regularly prompts jaundice (a yellow staining of the skin, mucous layer,
and conjunctiva), poor hunger, and discomfort. Hepatitis is intense when it keeps going under a
half year and endless when it continues longer. Intense hepatitis can act naturally constraining
(mending without anyone else), can advance to incessant hepatitis, or, infrequently, can cause
intense liver disappointment. (Bernal, 2013) Chronic hepatitis may have no side effects, or may
advance after some time to fibrosis (scarring of the liver) and cirrhosis (unending liver
disappointment) (Dienstag, 2012) Cirrhosis of the liver builds the danger of creating
hepatocellular carcinoma (a type of liver tumor). (Dienstag, Tumors of the Liver and Biliary
Tree, 2012)

Anatomy and Physiology of liver:

The liver is a crucial organ of vertebrates and some different creatures. In the human, it is in the
upper right quadrant of the midriff, underneath the stomach. The liver has an extensive variety of
capacities, including detoxification of different metabolites, protein combination, and the
generation of biochemicals essential for assimilation. The liver is an organ and assumes a
noteworthy part in digestion with various capacities in the human body, including control of
glycogen stockpiling, decay of red platelets, plasma protein amalgamation and detoxification. It
is an essential organ and produces bile, a basic compound which helps in assimilation by means
of the emulsification of lipids. The gallbladder, a little pocket that sits simply under the liver,
stores bile created by the liver. Liver's exceptionally particular tissue comprising of for the most
part hepatocytes manages a wide assortment of high volume biochemical responses, including
the blend and breakdown of little and complex atoms, a considerable lot of which are
fundamental for ordinary key capacities. (Maton, 1993). Evaluations with respect to the organ's
aggregate number of capacities differ, yet course readings for the most part refer to it being
around 500.There is as of now no real way to adjust for the nonappearance of liver capacity in
the long haul, albeit liver dialysis procedures can be utilized as a part of the here and now. Liver
transplantation is the main choice for finish liver disappointment.

Epidemiology of hepatitis viruses:

The Centers for Disease Control and Prevention (CDC) conducts national reconnaissance for
intense hepatitis A, B, and C. In 2007, 2979 instances of intense symptomatic HAV
contamination were accounted for. This was the most reduced frequency of HAV disease
recorded to that point and spoke to a 90% decrease from yearly cases revealed from 1995
through 2005. Since a decent arrangement of HAV diseases might be asymptomatic or may go

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unreported, the CDC assessed that the genuine number of new HAV contaminations in 2007 was
around 25,000. For HBV contamination, 4519 intense, symptomatic cases were accounted for in
2007—additionally the most reduced rate recorded to that point. With remedy for asymptomatic
cases and underreporting, the genuine number was evaluated to be 43,000 new contaminations in
2007.The frequency of youth HBV disease isn't entrenched, in light of the fact that over 90% of
such contaminations in youngsters are asymptomatic. Rates of HBV disease were most
noteworthy in non-Hispanic blacks in 2007 (2.3 cases for every 100,000). Constant HBV disease
has a higher predominance among Asian Pacific Islanders and no Hispanic blacks. The quantity
of affirmed instances of intense hepatitis C expanded somewhat for 2007, from 802 revealed
cases in 2006 to 849 out of 2007. The real number of new HCV contaminations in 2007 was
evaluated to be around 17,000. Around 70-90% of individuals Introduction Frequency of Renal
Diseases in Patients with Hepatitis C Virus3 contaminated advance to incessant HCV
contamination. Around 3.2 million individuals In the United States have incessant hepatitis C.
(Wasley, 2006) Worldwide, HAV oversees an expected 1.4 million contaminations yearly. HBV
causes more than 4 million instances of intense hepatitis every year all through the world, and it
is assessed that around 350 million individuals are incessantly tainted with the infection. HBV
prompts 1 million passing’s every year due to viral hepatitis– incited liver ailment. The overall
yearly occurrence of intense HCV contamination isn't effortlessly assessed, in light of the fact
that patients are regularly asymptomatic. An expected 170 million individuals are constantly
tainted with HCV around the world. China, the US, and Russia have the biggest populaces of
against HCV positive IV medicate clients (IDUs). It is evaluated that 6.4 million IDUs
worldwide are certain for immune response to HBcAg (hostile to HBc), and 1.2 million are
HBsAg-positive. (WHO)

Features of hepatitis viruses:

Viral hepatitis has risen significant medical issue comprehensively influencing a few people.
Viral hepatitis is an explanation behind bleakness and mortality in the human populace, both
from intense and interminable anomaly which join, since hepatitis B, C and D and cirrhosis.
Hepatocellular carcinoma which is one of the ten most normal malignancies around the globe, is
about related with hepatitis B, and in any occasion in a couple of regions of the world with
hepatitis C disease. The hepatitis contaminations fuse an extent of superfluous and frequently
exceptionally odd human pathogens.

Introduction to Hepatitis C Virus:

Hepatitis C is a liver ailment expedited by the hepatitis C contamination: the disease can achieve
both intense and perpetual hepatitis malady, running in reality from a smooth ailment bearing
two or three weeks to a genuine, durable sickness. The hepatitis C contamination is a bloodborne
infection and the most broadly perceived modes are through unsafe infusion works on; lacking
disinfection of restorative instruments; and the transfusion of unscreened blood and blood things.
130– 150 million people all around have incessant hepatitis C sickness. (Lozano R, 2012)

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Roughly 500 000 people pass on consistently from hepatitis C-related liver illnesses. Antiviral
pharmaceuticals can cure approximately 90% of people with hepatitis C contamination, thusly
diminishing the risk of death from liver development and cirrhosis, yet access to assurance and
treatment is low. There is at the present time no vaccination for hepatitis C. (Hepatitis C, 2015).

Transmission:
The fundamental course of transmission in the created world is intravenous prescription utilize
(IDU), while in the creating scene the standard frameworks are blood transfusions and hazardous
restorative strategies. (Maheshwari A, 2010) The people who have experienced a needle stick
harm from some individual who was HCV constructive have around a 1.8% plausibility of thus
getting the ailment themselves. The threat is more vital if the needle being alluded to is unfilled
and the cut damage is profound. There is a risk from mucosal exposures to blood; yet this peril is
low, and there is no threat if blood introduction is on in place skin. Healing facility hardware has
in like manner been filed as a procedure for transmission of hepatitis C, including reuse of
Introduction Frequency of Renal Diseases in Patients with Hepatitis C Virus 6 needles and
syringes; various usage tranquilizes vials; and despicably sterilizer surgical gear, among others.
(Adjust, 2007) Whether hepatitis C can be transmitted through sexual activity is questionable.
The overwhelming piece of affirmation support there being no peril for hetero couples with just a
single sexual accomplice. Sexual practices that incorporate more hoisted measures of damage to
the anogenital mucosa, for instance, butt-centric; penetrative sex, or that happen when there is a
concurrent sexually transmitted pollution, including HIV or genital ulceration, do display a
hazard. (Tohme RA, 2010) Tattooing identifies with two to triple extended threat of hepatitis C.
This can be a direct result of either disgracefully cleaned instrument or polluting of the hues
being utilized. Tattoos or piercings performed either before the mid-1980s, "underground," or
nonprofessionally are of stress, consequent to sterile procedures in such settings might be
deficient. The peril in like manner has every one of the reserves of being more vital for greater
tattoos. It is evaluated that about bit of prison detainees share unsterilized inking gear. (Jafari,
2010) Individual thought things, for instance, razors, toothbrushes, and manicuring or pedicuring
units can be sullied with blood. Sharing such things can provoke prologue to HCV. Suitable
alarm should be taken with respect to any therapeutic condition that results in kicking the bucket,
for instance, cuts and bruises. HCV isn't spread through easygoing contact, for instance,
grasping, kissing, or sharing eating or cooking utensils. (Communities for Disease Control and
Prevention (CDC), 2012).

Signs and symptoms:

Hepatitis C defilement causes extraordinary symptoms in 15% of cases. Side effects are gentle
and obscure, including a lessened craving, shortcoming, ailment, muscle or joint miseries, and
weight reduction (T, JK, D, and RR, 2010) and rarely does extraordinary liver frustration result.
(Bailey, 2010) Most occurrences of extraordinary illness are not related with jaundice. The
illness decides suddenly in 10– half of cases, which happens all Introduction Frequency of Renal

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Diseases in Patients with Hepatitis C Virus 7 the all the more from time to time in individuals
who are youthful and female. (Interminable Hepatitis C Virus Advances in Treatment, 2011)
Around 80% of those exhibited to the disease develop constant contamination. This is portrayed
as the nearness of distinguishable viral replication for least a half year. (Ceaseless Hepatitis C
Virus Advances in Treatment, 2011) Chronic hepatitis C can be related with shortcoming (Ray
and Thomas, 2009) and delicate scholarly issues. (Forton, et al., 2005) Chronic illness following
a significant extended period may achieve cirrhosis or liver malignancy. The liver proteins are
run of the mill in 7– 53%. Late backslides after clear cure have been represented, however these
can be difficult to perceive from reinfection. (F, 2004) Fatty changes to the liver occur in about
part of those polluted and are regularly present before cirrhosis creates. Normally (80% of the
time) this change impacts not precisely 33% of the liver. (AR, 2008) Worldwide hepatitis C is
the explanation behind 27% of cirrhosis cases and 25% of hepatocellular carcinoma. Around 10–
30% of that defiled make cirrhosis over 30 years. Cirrhosis is more essential in those moreover
polluted with hepatitis B, Schistosoma, or HIV, in substantial consumers and in those of male
sexual orientation. The individuals who make cirrhosis have a 20-crease more risk of
hepatocellular carcinoma. This change occurs at a rate of 1– 3% for consistently. (Bailey, 2010)
Being spoiled with hepatitis B despite hepatitis C grows this threat further. (Fattovich,
Stroffolini, Zagni, and Donato, 2004) Liver cirrhosis may provoke entrance hypertension, ascites
(aggregation of liquid in guts), basic injuring or passing on, varices (extended veins, especially in
the stomach and throat), jaundice, and a confusion of scholarly incapacity known as hepatic
encephalopathy. Ascites occurs at some phase in the greater part of the people who have an
incessant disease. (Ozaras R, 2009).

Pathophysiology of hepatitis C:
The reason for hepatitis C which is Hepatitis C Virus, is a circular, wrapped, single stranded
RNA infection having a place with the Flavivirid family and Flavivirus class. The characteristic
targets territory of HCV are hepatocytes and, might be, B lymphocytes. Viral freedom is related
with the advancement and reliably nearness of solid infection reactions by cytotoxic T
lymphocytes and aide T cells. In most tainted individuals, viremia remains and is related with
variable degrees of hepatic aggravation and fibrosis. Results from contemplates demonstrates
that no less than half of hepatocytes might be contaminated with HCV in patients with incessant
hepatitis C. RNA-subordinate RNA polymerase, a compound basic in HCV replication, have
decrease editing capacities and deliver numerous mutant infections known as semi species.
These demonstrate some atomic varieties with just 1-2% heterogeneity. HCV subspecies give a
noteworthy test to safe intervened control of HCV and may clarify the variable clinical course
and the issues looking in immunization advancement. (Dhawan and Fidsa, 2015)

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Diagnosis:
Powerful cloning of sections of the viral genome permitted the change of new symptomatic tests
for disease by the infection. Since the first antigen was distinguished by antibodies in the serum
of a tainted patient it was a prominent plausibility for the premise of an ELISA to perceive
against HCV antibodies. A greater clone, C100, was amassed from different covering clones and
communicated in yeast as a combination protein using human superoxide dismutase groupings to
support articulation, and this combination protein make the premise of unique tests for HCV
contamination. The C100 contains both NS3 and NS4 game plans. It is by and by understood that
antibodies to C100 are recognized by and large late after an intense contamination. Furthermore,
the original ELISAs were related with a high rate of Introduction Frequency of Renal Diseases in
Patients with Hepatitis C Virus 9 false positive outcomes when connected to low occurrence
populace, and there were further issues with some review learns about put away sera. Data in
perspective of this test alone should, thus, be deciphered with alert. Second era tests join antigens
from the nucleocapsid and further nonstructural territories of the genome. The past (C22) is
particularly profitable and antibodies to the HCV center protein seem to show up respectably
ahead of schedule in contamination. These second-age tests insist that HCV is the imperative
purpose behind parenterally transmitted non-A, non-B hepatitis. Routine testing of blood gifts is
as of now set up in various nations and commonness rates contrast from 0.2– 0.5% in northern
Europe to 1.2– 1.5% in southern Europe and Japan. The larger part of those with immune
response have a background marked by parenteral peril, for instance, history of transfusion or
organization of blood things or of intravenous prescription abuse. There is minimal evidence for
sexual or perinatal transmission of HCV and it isn't clear what are the customary courses of
transmission. The availability of the nucleotide grouping of HCV made conceivable the
utilization of the polymerase chain reaction (PCR) as a prompt test for the genome of the
infection. There are numerous varieties in nucleotide successions among disconnects of HCV,
and the 5′ non-coding locale, which is from every angle significantly rationed, is the favored
focus for the PCR. Current data prescribes that around 80% of contaminations with HCV
prompts chronicity. Histological examination of liver biopsies from asymptomatic HCV-
transporters (blood contributors) tells that none has ordinary histology and that up to 70% have
endless dynamic hepatitis and additionally cirrhosis. Regardless of whether the infection is
cytopathic or whether there is an immunopathological part remains dim. HCV sickness is
similarly connected with movement to essential liver growth. For example, in Japan, where the
event of hepatocellular carcinoma has been extending regardless of a diminishment in the
predominance of HBsAg, HCV is by and by seen as the essential hazard factor. Presentation
Frequency of Renal Diseases in Patients with Hepatitis C Virus 10 There is no DNA middle of
the road in the replication of the HCV genome or fuse of viral nucleic corrosive and viral
pathology may add to oncogenesis through cirrhosis and recuperation of liver cells. HCV rarely
seems to achieve fulminant hepatitis. (J.Zuckerman, 1996).

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Extrahepatic manifestations of HCV:
Hepatitis C infection disease is most presumably connected with additional hepatic indications,
optional to the enlistment of immune system responses, summed up aggregation of insusceptible
buildings and lymphoproliferative issue. The most evident affiliations are those connecting
incessant hepatitis C with blended cryoglobulinemia (and the related glomerulonephritis and
cutaneous vasculitis), and with the nearness of autoantibodies. Different less normally issue
incorporate non-Hodgkin's lymphoma, thrombocytopenia, celadonites, thyroid malady, lichen
planus, porphyria catenated, rheumatoid clutters and neurological issue. Additional hepatic
exhibits are most normally related in patients of female sex, propelled age, long-terms disease
and cirrhosis. Legitimate treatment design ought to be founded on the most widely recognized
exhibition of the infection. Because immune system issue not specifically related to the viral
disease, corticosteroids might be the most best decision. Interferon-α alone or in blend with
ribavirin might be chosen for those disarranges identified with invulnerable complex statement,
for example, blended cryoglobulinemia, even though backslides of additional hepatic signs
regularly happen on ceasing of treatment. At times, interferon-α may expand some additional
hepatic signs. (Medina, Buey, and Moreno-Otero, 2004) Infection with hepatitis C infection
(HCV) can advance to both intense and additionally unending hepatitis. What's more, there are
numerous extrahepatic signs of unending HCV contamination, including 1) Hematologic
ailments like cryoglobulinemia and lymphoma 2) Autoimmune disarranges e.g. thyroiditis 3)
Renal ailment Introduction Frequency of Renal Diseases in Patients with Hepatitis C Virus 11 4)
Dermatologic conditions like lichen planus and porphyria cutanea tarda. (Chopra and Flamm,
2015).

Renal Diseases associated with HCV:

There is an undeniable causal relationship between constant hepatitis C infection (HCV)
contamination and glomerular illness. There are huge numbers of renal sickness that have been
perceive including blended cryoglobulinemia, membranoproliferative glomerulonephritis
membranous nephropathy and polyarteritis nodosa (PAN). Crescentic glomerulonephritis might
be overdyed on any of these glomerular sores. Less ordinarily, other glomerular sores have been
perceived in HCV-tainted patients, including central segmental glomerulosclerosis (FSGS)
proliferative glomerulonephritis, and fibrillary and immunotactoid glomerulopathies. In a few
patients, glomerular malady might be clinically asymptomatic. (Kamar and Rostaining, 2014) In
1966, Meltzer and collaborators initially clarified the clinical appearances related with 'blended'
cryoglobulinemia. They portrayed a clinical trial that comprised of tangible purpura, arthralgias
and shortcoming in addition to variable degrees of GN, lymphadenopathy in a few patients.
Cryoglobulinemia in these patients had a 'blended' arrangement of IgG and IgM rheumatoid
factor (RF). The basic reason of this sickness was altogether obscure back then, and its
relationship with HCV contamination just turned out to be progressively clear after its disclosure
in 1989. It is currently evident that the established clinical set of three just happens in a portion

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of the patients. The most well-known exhibit is the notably heterogeneous introductions of
fundamental vasculitis, with purpuric skin sores that show leukocytoclastic vasculitis on biopsy
being a relatively steady and overwhelming component of HCV virology. Other exceptional
types of glomerular damage related with HCV contamination incorporate membranous GN, IgA
nephropathy, central and segmental glomerulosclerosis, fibrillary GN, immunotactoid GN
quickly dynamic GN, exudative– proliferative GN, and lupus nephritis. Membranous
nephropathy in HCV bearers is portrayed by nonattendance of cryoglobulin and male prevalence.
(Lai, 2011).

Pathophysiology of Renal Diseases associated with HCV:

Toll like receptor likewise assume critical part in HCV related renal damage. TLR are essential
proteins which are communicated on resistant and also non-insusceptible cells as a noteworthy
segment of intrinsic safe framework. TLR works by perceiving the sub-atomic example related
with microbial pathogen and initiate invulnerable reaction. Renal biopsy finds the expanded
articulation of TLR3 particularly in miniaturized scale analyzed glomeruli of patient tainted with
HCV related glomerular disease(SchmidHengerA).

Treatment:
Hepatitis C infection (HCV) contamination is a major medical problem in patients with end-
organize renal illness (ESRD). The rate of intense HCV disease amid support dialysis is
considerably more noteworthy than that in the overall public because of the danger of
nosocomial transmission. Following intense HCV contamination, most patients create unending
HCV disease, and a significant extent create constant hepatitis, cirrhosis, and even hepatocellular
carcinoma. By and large, unending hepatitis C patients on hemodialysis experiencing expanded
danger of liver-related dreariness and mortality, either amid dialysis or after renal
transplantation. Interferon (IFN) treatment is relatively viable for the treatment of HCV
contamination in ESRD patients. Customary IFN monotherapy has been utilized to treat intense
hepatitis C in ESRD patients with extraordinary security and viability. With respect to hepatitis
C, around 33% of patients can accomplish a maintained virologic reaction (SVR) after ordinary
IFN monotherapy. The mix of low-measurement ribavirin and regular IFN has additionally
enhanced the SVR rate in treatment-gullible or withdrew ESRD patients in clinical trials. Of
note, IFN-based treatment isn't prescribed at the post-renal transplantation organize because of
low SVR rate and danger of intense unite dismissal. Taking everything into account, ESRD
patients with HCV disease ought to be urged to get antiviral treatment, and the individuals who
accomplish a SVR more often than not have long haul, tough, virologic, biochemical, and
histological reactions. (Liu and Kao, 2011)

Prevention:

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Presently there is no immunization against the hepatitis C infection. Thus, to keep from the
infection and other blood borne ailments, individuals should:

 Cover cuts and scratches with proper dressings.

 Hygienically discard blood recolored things, for example, wraps and sterile napkins.
 Avoid sharing individual things which might be tainted with blood, (for example,
toothbrushes and razors).
 Avoid sharing medication infusing gear.
 Avoid inking, needle therapy or ear puncturing where the gear isn't known to be
appropriately disinfected.
 Practice safe sex.
 People with the hepatitis C infection ought to exhort their dental practitioner or some
other wellbeing proficient that they are transporters of the infection. (Dhawan L. , 2013).

REVIEW OF LITRATURE
Case No 1:
This examination was led in 2007 by Lorien S. Dalrymple,Thomas Koepsell, Joshua Sampson,_
Tin Louie, Jason A. Dominitz Bessie Young,and Bryan Kestenbaumthe ponder demonstrates that
extent with renal deficiency was bring down for counter acting agent positive versus - negative
veterans (4.8 versus 6.0%), after adjustment for age, race, sexual introduction, diabetes, and
hypertension, HCV-positive veterans had a 40% higher chances for renal deficiency (chances
proportion 1.40; 95% certainty interim 1.11 to 1.76) as contrasted and HCV-negative
veterans.HCV was related with an awesome prevalence of renal inadequacy (Lorien S.
Dalrymple, 2007).

Case No 2:
The examination was held in 2007 by Judith I. Tsui, Eric Vittinghoff, Michael G. Shlipak,
Daniel Bertenthal, John Inadomi, MD; Rudolph A. Rodriguez, Ann M. O'Hare.Of 474369
patients in the accomplice, 52874 (11.1%)had a positive HCV neutralizer test result. Patients
with HCV will probably create ESRD, the rate per 1000 man for every year was 4.26 (95%
certainty interim, 3.97-4.57) for HCV-seropositive patients versus 3.05 (95% certainty interim,
2.96-3.14) for HCV-seronegative patients. For patients matured 18 to 70 years with an expected
glomerular filtration rate of no less than 30 mL/min per 1.73 m2, HCV seropositivity was related
with a more prominent than 2-overlay chance for creating ESRD (balanced danger rate, 2.80;
95% certainty interim, 2.43-3.23) (Judith I. Tsui, et al., 2007)

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Case No 3:
This investigation was directed in 2011 by Zohreh Rostami, Mohammad Hussain Norbala, Syed
Moayed Alavian, Fatemeh Bieraghdar, YunesJahani, Behzad Einollahi. The joined peril
proportion in HCV-tainted beneficiaries was 1.69-crease (1.33-1.97, p < 0.0001) and 1.56 times
(1.22-2.004, p < 0.0001) more noteworthy than that of HCV-negative beneficiaries for mortality
and unite misfortune, individually (Zohreh Rostami, 2011).

Case No 4:
This examination was directed in 2011 by Gioacchino Li Cavoli , Angelo Ferrantell, Luisa Bono,
Calogera Tortorici,Carlo Giammarresi, Carmela Zagarrigo, Onofrio Schillaci, Ang elo
Tralongo,Maurizio Soresi, UgoRotolo. Among 320 CKD patients on moderate therapy,we
recognized 24 IgG HCV-positive subjects. Among these patients, four were HCV-RNA-negative
and 20 were HCV-RNA-positive. The rate of HCV disease was 6.25%. All subjects were
hepatitis B surface antigen (HBsAg)- negative, four patients were hepatitis B surface counter
acting agent (HBsAb)or hepatitis B center immunizer (HBcAb)- positive. This recognized
genotype 1b of every 17 patients and 2a/2c out of three patients (Gioacchino Li Cavoli, 2011).
Case No 5:
This investigation was directed in 2013 by Yi-Chun Chen, Wen-Yen Chiou, Shih-Kai Hung, Yu-
Chieh Su and Shang-Jyh Hwang in this examination the mean follow-up spans were 5.88 years
and 5.92 years for the HCV-tainted and control gatherings, separately. Among the example of
15910 subjects, 251 subjects (1.6%) created CKD amid the 6-year follow up period, 64 subjects
(2.0%) from the HCV-contaminated gathering and 187 subjects (1.5%) from the control
gathering. The rate of CKD was altogether higher in the HCV contaminated gathering than in the
control gathering (3.42 versus 2.48 for each 1000 man years, p = 0.02). Multivariate examination
demonstrated that the HCV-tainted gathering had fundamentally more noteworthy Literature
Review Frequency of Renal Diseases in Patients with Hepatitis C Virus 16 chance for CKD
(balanced risk proportion: 1.75, 95% CI: 1.25-2.43, p = 0.0009). This relationship likewise held
for an examination of HCV-contaminated and HCV-uninfected subjects who were more youthful
than 70 years and had none of customary CKD hazard factors. HCV contamination is related
with expanded hazard for CKD past the outstanding conventional CKD chance elements (Yi-
Chun Chen, 2013).

Objectives:
Objective of this study was to determine the Renal Diseases in Hepatitis C Virus patients.

Rationale:
Hepatitis and renal ailments are most regular illnesses of Pakistan, so there is a need of a perfect
setting to discover the connection between Hepatitis C Virus and Renal Diseases.
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 MATERIAL AND METHODS
Study Population:
HCV positive subjects.

Clinical setting:
This present study was conducted at the Liver Center Hospital and Chiniot Hospital Faisalabad.

Study Duration:
The study was completed in four months from September 2017 to December 2017.

Study Design:
It was Observational Descriptive study.

Sample size and sampling technique:

A Total of 99 consecutive samples were collected.

Inclusion criteria:
HCV positive patients were included.

Data Collection Instrument: A pre-designed Performa was used to collect patient’s data.

Operational Definitions:

Hepatitis C: Hepatitis C is a viral infection that affects the liver. Infection with the Hepatitis C
Virus (HCV) can either cause an acute or a chronic infection which may be lifelong.

Renal Diseases:
At the point when the kidneys wind up plainly harmed, squander items and liquid can develop in
the body, causing swelling in your lower legs, retching, shortcoming, poor rest and shortness of
breath. On the off chance that left untreated, infected kidneys may in the long run quit working
totally. Loss of kidney work is a genuine and possibly deadly condition.

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Urea:
Urea (also known as carbamide) is a waste product of many living organisms, and is the major
organic component of human urine. This is because it is at the end of chain of reactions which
break down the amino acids that make up proteins.

Serum Creatinine:
A creatinine blood test measures the level of creatinine in the blood. Creatinine is a waste item
that structures when creatinine separates.

Methodology

Urea:
Urea is measure by Diacetylmonoxime method. When urea is heated with diacetyl in an acidic
medium yellow color is produced.

Requirements:
 Spectrophotometer
 Appropriate covets,
 Test tubes and rack.
 Automated Poppets
 Incubator

Urea Reagent: Diacetylmonoxime.

Urea Standard Solution: Store in refrigerator at 0-5 degree centigrade.

Procedure:
 Tubes were labelled by me as Blank, Standard, Test 1, Test 2 etc.
 1mL Urea Reagent was added by me into each tube.
 10 micro liter serum was added into tubes labelled test.
 10 micro Liter standard (s) into tubes labelled standard.
 10 micro liter water into tubes labelled blank contents were mixed gently.
 Tubes were mixed prior to reading the absorbance.
 Wavelength of spectrophotometer was set at 420nm. Zero with the Reagent Blank.
 Absorbance then read and recorded.

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Creatinine:

Requirements:
 Spectrophotometer
 Appropriate covets,
 Test tubes and rack.
 Automated Poppets

Reagents: Sodium Hydroxide Solution, Acid Reagent Picric Acid, Creatinine Standard

Procedure: Alkaline picrate solution was prepared.

 Tubes were labelled as standard(s), test(s)
 400ul R1 was added in standard(s) tube and Test.
 100ul R2 added to standard and test(s) tube.
 Add 50ul serum into test and 50ul standard into standard tube.
 Mixed and allowed to incubate at room temperature.
 Read and recorded the absorbance at 490-510nm.

Ethical issues: This study is not involving any ethical issue.

Statistical Analysis: The information was entered and broke down by utilizing standard
IBM-SPSS programming V-20 (SPSS Inc, Chicago) for measurable examination. The constant
variable was communicated as mean ±standard deviation, while downright factor was depicted
as recurrence. Bar diagrams were utilized to show the information.

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RESULTS
Out of 99 patients 69(69.7%) were male and 30(30.3%) were female as appeared in table.

Frequency Percentage

Male 69 69.7

Female 30 30.3

Total 99 100.0

Table No.4.1: Gender Distribution among Patients

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 Std.

N Minimum Maximum Mean Deviation

Age of patient 99 28 81 52.23 11.61

Table No.4.2 Age of Patients

Urea and Creatinine were performed on patients. Urea and Creatinine was normal in
36(36.4 %) and strange in 63(63.6 %) as appeared in Table No 4.3. Out of 63 patients,
33(33.3%) patient's Urea was inside scope of 21-100, 23(23.2%) inside scope of 101-180
and 7(7.1%) inside scope of 181-260 as appeared in Graph No. 4.2.

The Creatinine was performed on 99 patients. Creatinine was typical in 36 patients and 63
patients were irregular in run. Level of patients which are inside ordinary points of confinement
were 36.4% and the level of patients whose are out of range were 63.6% as appeared in the
Graph No 4.3.

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 Positive Percentage Negative Percentage

Urea 63 63.6 36 36.4

Creatinine 63 63.6 36 36.4

Table No. 4.3Renal diseases associated with Hepatitis C Virus

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Discussion
Hepatitis C Virus is a most regular viral pathogen that presently contaminates 130– 150 million
people all around world. Hepatitis C is a liver malady caused by the hepatitis C infection
contamination. Disease can be intense and interminable. Hepatitis C running from a smooth
ailment persevering through two or three weeks to a genuine, durable sickness. People with
endless HCV may advance to liver fibrosis and thusly cirrhosis and hepatocellular carcinoma,
which are the significant weight of infection in individuals living with unending hepatitis C.
Hepatitis C disease is a blood borne infection and the most broadly perceived modes are through
dangerous infusion works on; lacking sanitization of medicinal instruments; and the transfusion
of unscreened blood and blood things. Hepatitis C contamination and endless kidney infection
are real wellbeing trouble around the world. Hepatitis C Virus is related with renal infections
including blended cryoglobulinemia, membranoproliferative glomerulonephritis, membranous
nephropathy, and polyarteritis nodosa. A solid relationship between Hepatitis C and renal
maladies has become exposed. Despite much change under the watchful eye of this gathering of
patients, the commonness of Hepatitis C contamination in kidney patients is as yet higher than
the all-inclusive community. Hepatitis C disease negatively affects the survival of kidney
patients as in hemodialysis and renal transplant patients. The outcomes showed that Urea and
Creatinine were performed on 99 patients. Out of 99 patients 69(69.7%) were male and
30(30.3%) were female and the mean period of patients was 52.23 ± 11.61 years. The outcome
demonstrated that Urea and Creatinine was certain in 63(63.6%) and negative in 36(36.4%).
Concentrate detailed that the frequency of renal sicknesses in HCV positive patients is high. The
investigation was held in 2007 byJudith I. Tsui, Eric Vittinghoff, Michael G. Shlipak, Daniel
Bertenthal, John Inadomi, MD; Rudolph A. Rodriguez, Ann M. O'Hare. This examination
upheld my investigation as out of 474369 patients, 52874 (11.1%)had a positive HCV immune
response test result.

Conclusion:
Hepatitis C Virus contamination remains a noteworthy medical problem in kidney illness
patients detailed at Liver Center Hospital and Chiniot Hospital Faisalabad. The reason for this
examination was to decide the recurrence of renal ailments in Hepatitis C Virus Infected
Patients. For this reason, HCV, positive patients were researched at Liver Center Hospital and
Chiniot Hospital Faisalabad. Considering this investigation it is presumed that recurrence of
kidney illnesses in HCV patients is high in the clinical setting of Liver Center Hospital and
Chiniot Hospital Faisalabad.

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