Supplementary Material for: Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

<b><i>Introduction:</i></b> The side effects profile of the new direct-­acting antivirals for the treatment of hepatitis C virus (HCV) is not fully elucidated. <b><i>Objective:</i></b> In this cross-sectional study, we aim to describe the incidence and characteristics of a novel observation of de novo renal cryoglobulinemic glomerulonephritis after successful treatment with DAA. <b><i>Methodology:</i></b> A total of 12,985 Hepatitis C Patients (genotype IV) received the new DAA. After successful treatment, patients with deranged renal functions or proteinuria were referred to the nephrology department for assessment. The clinical manifestations ranged from lower limb edema to the development of purpura skin lesions. Cryoglobulins were tested in the serum using the PCR detection. <b><i>Results:</i></b> Fifty patients had detectable de novo cryoglobulins in the serum. The most common type in renal biopsies was membranoproliferative glomerulonephritis (52%) and chronic kidney disease (CKD) developed in 46% of cases. <b><i>Conclusion:</i></b> De novo cryoglobulinemic glomerulonephritis and progression to CKD may rarely complicate successful treatment of HCV using direct-acting antivirals.

<b><i>引言：</i></b> 用于治疗丙型肝炎病毒（hepatitis C virus, HCV）的新型直接抗病毒药物（direct-acting antivirals, DAA）的不良反应谱尚未完全阐明。<b><i>研究目的：</i></b> 本横断面研究（cross-sectional study）旨在描述接受直接抗病毒药物成功治疗后新发肾冷球蛋白血症性肾小球肾炎（renal cryoglobulinemic glomerulonephritis）这一新型观察结果的发生率与特征。<b><i>研究方法：</i></b> 共计12985例基因型IV型丙型肝炎患者接受了新型直接抗病毒药物治疗。治疗成功后，存在肾功能异常或蛋白尿的患者被转诊至肾脏内科进行评估。患者的临床表现从下肢水肿到皮肤紫癜病变不等。采用聚合酶链反应（PCR）检测患者血清中的冷球蛋白。<b><i>研究结果：</i></b> 共计50例患者血清中可检测到新发冷球蛋白。肾活检标本中最常见的病理类型为膜增生性肾小球肾炎（membranoproliferative glomerulonephritis）（占比52%），46%的病例进展为慢性肾脏病（chronic kidney disease, CKD）。<b><i>结论：</i></b> 采用直接抗病毒药物成功治疗丙型肝炎后，新发肾冷球蛋白血症性肾小球肾炎及进展为慢性肾脏病或为罕见的治疗相关并发症。