Recurrent Hepatitis C-Related Membranoproliferative Glomerulonephritis in a Simultaneous Liver-Kidney Transplant Recipient With Atypical Presentation and Clinical Course
Bibliographic record
Abstract
Hepatitis C virus (HCV) infection is known to be associated with membranoproliferative glomerulonephritis (MPGN) with or without coexistent cryoglobulinemia. We report a patient with end-stage liver and renal disease caused by HCV infection (biopsy-proven liver cirrhosis and MPGN, respectively). Approximately 10 months after simultaneous liver-kidney transplantation, patient developed severe acute kidney injury (AKI) with tripling of the baseline serum creatinine level. Allograft biopsy showed recurrent HCV-related cryoglobulinemic MPGN. However, urinalysis done immediately prior to biopsy did not suggest MPGN (lack of proteinuria and microscopic hematuria). Subsequent clinical course was also atypical in that the severe AKI resolved spontaneously and completely over 2 weeks without any change in maintenance post-transplant immunosuppressive medications, or use of plasmapheresis or HCV-antiviral therapy. Three months after resolution of recurrent MPGN-related AKI, institution of interferon-free anti-HCV therapy (sofosbuvir + ribavirin) resulted in clearance of HCV viremia over 18 weeks while liver and kidney transplant function remained stable/good. This patient illustrates the following: HCV-related MPGN may recur in the kidney transplant without typical urinary findings, and the resultant (even severe) AKI may resolve spontaneously without specific treatment and the excellent outcome that can be achieved with the newer anti-HCV therapies. World J Nephrol Urol. 2014;3(4):157-161 doi: http://dx.doi.org/10.14740/wjnu185e
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".