{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:22Z","timestamp":1753891222818,"version":"3.41.2"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Glecaprevir\/pibrentasvir is an effective antiviral therapy for hepatitis C virus infection and is generally regarded safe in patients with renal impairment. However, renal complications are a notable, albeit rare, concern.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report a case of acute kidney injury in a man in his 50s with chronic hepatitis C virus, chronic obstructive pulmonary disease, morbid obesity, a history of heroin dependence, and untreated type 2 diabetes mellitus. About four weeks into an eight-week glecaprevir\/pibrentasvir regimen he developed progressive lower extremity edema, bullae, and skin ulcers with worsening renal function. His serum creatinine rose to 4.46\u202fmg\/dL and blood urea nitrogen to 44\u202fmg\/dL. ANCA serology revealed dual perinuclear and cytoplasmic positivity, though anti-proteinase 3 and anti-myeloperoxidase antibody tests were negative. Kidney biopsy revealed diffuse tubulointerstitial injury with erythrocyte casts indicative of glomerular bleeding into the distal nephrons, though without glomerular crescent formation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case illustrates the potential for glecaprevir\/pibrentasvir to induce acute kidney injury, acute interstitial nephritis and possibly ANCA-associated vasculitis. Recognizing these adverse renal effects is critical for making timely diagnosis and management in hepatitis C virus patients undergoing antiviral therapy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1434497","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T04:11:14Z","timestamp":1736914274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute kidney injury and ANCA positivity in a patient treated with glecaprevir\/pibrentasvir: a case report"],"prefix":"10.3389","volume":"11","author":[{"given":"Lawrence Hyun","family":"Kwon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Griffiths","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanny","family":"DiFranza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1093\/cid\/ciz022","article-title":"Safety and pharmacokinetics of Glecaprevir\/Pibrentasvir in adults with chronic genotype 1\u20136 hepatitis C virus infections and compensated liver disease","volume":"69","author":"Gane","year":"2019","journal-title":"Clin Infect Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e00587","DOI":"10.14309\/crj.0000000000000587","article-title":"Acute kidney injury presenting as Hepatorenal syndrome in the setting of Glecaprevir\/Pibrentasvir treatment for hepatitis C","volume":"8","author":"Fansiwala","year":"2021","journal-title":"ACG Case Rep J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.transproceed.2021.12.028","article-title":"Glecaprevir\/Pibrentasvir and renal dysfunction in deceased donor renal transplantation: a case report","volume":"54","author":"Kaba","year":"2022","journal-title":"Transplant Proc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2215\/cjn.03710708","article-title":"Hepatitis C infection and chronic renal diseases","volume":"4","author":"Perico","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"156","DOI":"10.5414\/cn107179","article-title":"Acute interstitial nephritis after amoxycillin with hematuria, red blood cell casts and hematuriainduced acute tubular injury","volume":"80","author":"Ferrari","year":"2013","journal-title":"Clin Nephrol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1159\/000491629","article-title":"Case report: patient with hepatitis C, p-ANCA, and Cryoglobulin antibodies presenting with necrotizing crescentic p-ANCA glomerulonephritis","volume":"8","author":"Hanna","year":"2018","journal-title":"Case Rep. Nephrol. Dial."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/bor.0b013e3282f1331f","article-title":"Drug-induced vasculitis","volume":"20","author":"Wiik","year":"2008","journal-title":"Curr Opin Rheumatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"547","DOI":"10.5527\/wjn.v5.i6.547","article-title":"Antineutrophil cytoplasmic antibodies crescentic allograft glomerulonephritis after sofosbuvir therapy","volume":"5","author":"Gadde","year":"2016","journal-title":"World J Nephrol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.2215\/cjn.02500317","article-title":"ANCA glomerulonephritis and Vasculitis","volume":"12","author":"Jennette","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s10157-020-01925-5","article-title":"ANCA-associated nephritis without crescent formation has atypical clinicopathological features: a multicenter retrospective study","volume":"24","author":"Zoshima","year":"2020","journal-title":"Clin Exp Nephrol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s10157-012-0735-y","article-title":"ANCA testing: the current stage and perspectives","volume":"17","author":"Csernok","year":"2012","journal-title":"Clin Exp Nephrol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1016\/j.cll.2019.07.003","article-title":"Antineutrophil cytoplasmic antibodies testing and interpretation","volume":"39","author":"Allard-Chamard","year":"2019","journal-title":"Clin Lab Med"},{"key":"ref13","first-page":"294","article-title":"Antineutrophil cytoplasmic antibodies (ANCA): diagnostic utility and potential role in the pathogenesis of vasculitis","volume":"12","author":"Malenica","year":"2004","journal-title":"Acta Dermatovenerol Croat"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/md.0b013e318161b0fc","article-title":"Acute Postinfectious glomerulonephritis in the modern era","volume":"87","author":"Nasr","year":"2008","journal-title":"Medicine"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"sfae054","DOI":"10.1093\/ckj\/sfae054","article-title":"The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review","volume":"17","author":"Muhammad","year":"2024","journal-title":"Clin Kidney J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"833","DOI":"10.2215\/cjn.12591117","article-title":"Acute kidney injury and risk of heart failure and atherosclerotic events","volume":"13","author":"Go","year":"2018","journal-title":"Clin J Am Soc Nephrol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1434497\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T04:11:17Z","timestamp":1736914277000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1434497\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,15]]},"references-count":16,"alternative-id":["10.3389\/fmed.2024.1434497"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1434497","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,1,15]]},"article-number":"1434497"}}