Dear Alice,

My brother has Hepatitis C. He is having problems with water retention and has holes in his kidneys. How should HCV be treated and how should the damage to his body be treated? Can we protect ourselves? Need help.

DB

Dear DB,

First off, it’s great that you're taking the time to look into how you can help your brother and help protect yourself and your family! Before delving into the answers to your questions, it's good to note that Go Ask Alice! can answer general questions, but the specific concerns about your brother’s Hepatitis C virus (HCV) are best answered by talking with his health care team. With that said, there is no way to completely reverse the damage from an HCV infection; treatment typically involves addressing the initial infection, preventing future damage, and addressing any resulting complications. Along those lines, it's possible that the water retention and kidney damage you've described are complications of Hep C and likely require specific treatment in addition to the general management of the HCV infection. The good news is that the risk for you and your other family members contracting the virus is low, since HCV is passed through blood-to-blood contact. Read on for more on general management of an HCV infection, addressing potentially related complications, and how to minimize the transmission of the virus to you and your family.

Health and medical management for a person with Hep C can range from taking antiviral medications and making lifestyle adjustments (such as maintaining a healthy diet and avoiding alcohol use) to undergoing dialysis or having a liver or kidney transplant if either of those organs become very damaged. In addition, addressing any complications associated with the infection through additional medications or procedures is often part of the treatment plan. There are a range of complications that can result from Hep C infection, but damage to and scarring of the liver (cirrhosis) is one of the most common and it’s possible that it may be related to your brother’s water retention. To break it down further: the liver is the main source of the protein called albumin. Low albumin levels, commonly associated with cirrhosis, can negatively impact the body's ability to regulate fluids. This, in turn, can result in a build up of water in the body called edema. Although a health care provider will be able to give a more tailored treatment plan, some people with edema due to low albumin levels are advised to reduce dietary salt intake. High salt foods will encourage the body hold onto more water, and make edema worse, so lowering salt intake can lessen the body’s desire to hold water. Similarly, taking a diuretic can help the body get rid of extra sodium through urination and decrease the amount of water being stored.

Though it's unclear what exactly could've caused the "holes" in your brother's kidneys, some people with HCV do develop kidney problems. One such condition involving the kidneys, called glomerlulonephritis or glomerular disease, is also counted among the recognized complications associated with hepatitis C. In this situation, the body sends inflammatory cells to the kidney in an attempt to fight off an infection. The inflammatory cells then attack the kidney’s delicate filtering units, the glomeruli, which carefully sift through all of your body’s fluids to decide what will stay in the blood and what will pass along to be converted into urine as a waste product. When the glomerulus is damaged due to a virus such as HCV, the urine may be pink or foamy due to blood or protein getting through the filtration system and into the urine. This protein loss can make edema (especially in the face, hands, feet, and belly) worse. Once a health care provider is able to assess the underlying cause and the severity of the condition itself, s/he can determine the types of therapies that are most appropriate to treat it. This typically includes treating the underlying cause with medications (such as antiviral and immunosuppressive medications) as well as therapies to treat related symptoms. Commonly utilized medications aim to decrease the amount of protein leaking into the urine and to treat high blood pressure and edema. For some people with advanced damage that goes untreated, a liver or kidney transplant may be necessary.

While treating Hepatitis C and any complications require medical intervention, simply knowing more about the ways in which the virus can be transmitted may hopefully put your mind at ease and help keep you and the rest of your family protected. First, it's good to know that HCV is very rarely passed between people who live together (or even between romantic partners). While there is no vaccine for the virus yet, it can’t be passed through casual contact like hugging, kissing, holding hands, or sharing or preparing food. It’s also not passed through sneezing, kissing, or coughing. Some sources have suggested not sharing razors or toothbrushes as a way to minimize the risk of contracting HCV from a family member, but the most common ways that HCV is spread is from mother to child in pregnancy and birth, through shared needles, or from accidental needle sticks. Lastly, before 1992, when screening for HCV in blood became available, some people contracted the virus through blood transfusions — but, this is very rare in the United States nowadays.

All this to say, your brother is lucky to have such a great health advocate in his corner. In order to learn more about how you can support his treatment plan, there's certainly no harm in talking further with your brother's health care team. And, although health care providers may not always disclose the full details of another family member’s condition, they are a good resource for family concerns and can offer personalized help for planning long-term support — not just for your brother, but for you and the rest of your family. If you're interested in doing a bit more homework on the subject, you might also check out the American Liver Foundation's Hep C 123 website for more information.

Alice!

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