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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".