The combination of sofosbuvir and daclatasvir is effective and safe in treating patients with hepatitis C and severe renal impairment.

BACKGROUND AND AIM: Many of the treatment regimens available for hepatitis C include sofosbuvir. Unfortunately, sofosbuvir has not been recommended for use in patients with severe renal impairment leaving these group of patients with very few options. Nevertheless, there are many reports in which these patients have been treated with sofosbuvir-containing regiments without important adverse events. This study aims at determining the safety and effectiveness of a sofosbuvir-based treatment in patients with severe renal impairment, including those on hemodialysis. METHOD: We enrolled subjects with hepatitis C and estimated glomerular filtration rate under ml/min/1.73m2 from 13 centers in Iran. Patients were treated for 12 weeks with a single daily pill containing 400-mg sofosbuvir and 60-mg daclatasvir. Patients with cirrhosis were treated for 24 weeks. Response to treatment was evaluated 12 weeks after end of treatment (sustained viral response [SVR]). ClinicalTrials.gov identifier: NCT03063879. RESULTS: A total of 103 patients were enrolled from 13 centers. Seventy-five patients were on hemodialysis. Thirty-nine had cirrhosis and eight were decompensated. Fifty-three were Genotype 1, and 27 Genotype 3. Twenty-seven patients had history of previous failed interferon-based treatment. Three patients died in which cause of death was not related to treatment. Six patients were lost to follow-up. The remaining 94 patients all achieved SVR. No adverse events leading to discontinuation of medicine was observed. CONCLUSIONS: The combination of sofosbuvir and daclatasvir is an effective and safe treatment for patients infected with all genotypes of hepatitis C who have severe renal impairment, including patients on hemodialysis.

Protective effects of Vitex pseudo-negundo leaves on diabetic-induced nephropathy in rats.

Objectives The belief of therapeutic effects of herbal remedies in diseases such as diabetes is rooted in medical history. The present study evaluated protective efficacy of the hydroalcoholic extract of Vitex pseudo-negundo leaves (VLHE) on the renal disorders in streptozotocin-induced diabetic rats. Methods Fifty Wistar male rats were recruited and divided into five groups of 10, including healthy controls and diabetic controls: three diabetic groups of which first group was treated with glibenclamide, and two groups treated with 250 and 500 mg/kg of VLHE, respectively, for six weeks. Renal biochemical tests and tissue histopathological evaluation were performed and the antioxidant status was examined. Results There were significant decreases in superoxide dismutase and glutathione peroxidase activities and increases in malondialdehyde levels in renal tissue of diabetic groups compared with healthy controls. In the VLHE-treated rats, fasting blood sugar, blood urea nitrogen and creatinine were declined, serum albumin elevated, kidney weight lowered, lipid peroxidation and reinforcement of the activities of antioxidant enzymes decreased compared with healthy groups. Histological assessments revealed that the vacuolar degeneration of tubules and shrinkage of glomeruli in VLHE-treated rats was decreased compared with diabetic rats. Conclusions The study suggested that administrating of VLHE in nephropathic rats ameliorated the disease by reduction of oxidative stress and increase in renal antioxidant enzyme activities.