هپاتیت C در مبتلایان به مرحله پایانی بیماری کلیه، تحت درمان با همودیالیز

نوع مقاله: مروری

نویسندگان

مرکز تحقیقات نارسائی مزمن کلیه، دانشگاه علوم پزشکی جندی‌شاپور اهواز، اهواز، ایران.

چکیده

ویروس هپاتیت  C(HCV) یکی از علل مهم هپاتیت ویروسی در مبتلایان  به بیماری پیشرفته کلیه است که همواره باعث زیان­های اقتصادی و اجتماعی شدید می­شود. از عوامل خطر و یا راه انتقال عمده HCV می­توان به پیوند عضو، همودیالیز طولانی مدت و نوع دیالیز اشاره کرد. هرچند در گذشته انتقال خون به عنوان یکی از عوامل خطر مهم  بود، اما امروزه، انتقال خون دیگر به عنوان عامل خطر مستقل انتشار HCV در افراد همودیالیزی محسوب نمی­شود. هم اکنون، برای غربالگری این بیماران از نظر هپاتیت C  توصیه می شود که درهمه بیماران همودیالیزی آنتی­بادی اختصاصی ضد ویروسC (anti-HCV) در بدو پذیرش و سپس هر شش ماه اندازه گیری شود. نظر به اینکه،
 در سیر هپاتیت C  ارتباط مستقیمی بین شدت تغییرات بافت کبد و سطح  HCV-RNAدیده نمی­شود، تنها ابزار دقیق ارزیابی شدت عفونت بیوپسی کبد است. استفاده از ریباویرین در بیماران با فیلتراسیون گلومرولی زیر ml/min/1.73m250 و همچنین PEG-IFN در مبتلایان به نارسایی کلیه توصیه نمی­شود. اما، درمان تک دارویی با اینترفرون آلفا (IFN-α) در بیمارانی که مبتلا به عفونت HCV بوده و کاندیدای پیوند کلیه­اند، مناسب­ترین درمان است.
 

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