Background. The natural course of adult hepatitis B virus (HBV)—related membranous nephropathy in areas where HBV infection is endemic (characterized by vertical and horizontal transmissio...

https://www.nejm.org/doi/pdf/10.1056/NEJM199105233242103

Membranous nephropathy related to hepatitis B virus in adults.

A direct causal association between hepatitis B virus (HBV) infection and the development of nephropathy remains controversial Epidemiological studies have shown that chronic carriage of HBV in some individuals (particularly children) leads to the development of nephrotic syndrome with a strong male predominance, the commonest histological type being membranous nephropathy (MN) Spontaneous clearance of HBV antigens (particularly the HBeAg) leads to abrogation of proteinuria The isolation of immune complexes in the kidney suggests that the pathogenesis of the disease may have an immune-complex basis Recent studies showing expression of HBV viral antigens in kidney tissue suggest direct viral-induced pathological alterations and chronic immunologic injury Biosocial studies have detected no correlation between HBV carriage and proteinuria using both quantitative and qualitative urinary protein analysis Genetic studies of HLA class I and II genes showed a predisposition to MN but no similar correlation in those with milder degrees of proteinuria These findings suggest that milder proteinuria is unrelated to HBV carriage or genetic factors but the development of nephropathy, particularly MN, in patients with chronic HBV carriage (HBsAg and/or HBV DNA positive) is based on an interaction of virus and host factors Although the natural history of the disease tends to remission with preservation of renal function, there is considerable morbidity and a small but significant mortality Use of naturally occurring cytokines (such as interferon-alpha2b) and other candidate therapies accelerates clearance of the virus and proteinuria The most effective tool in reducing the incidence of the disease is the use of HBV vaccines

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Hepatitis B virus-associated nephropathy.

Extrahepatic manifestations of chronic hepatitis B.

https://www.kidney-international.org/article/S0085-2538(15)34965-6/pdf

Hepatitis C infection in two urban hemodialysis units

https://www.kidney-international.org/article/S0085-2538(15)51027-2/pdf

Lamivudine in hepatitis B-associated membranous nephropathy

The therapeutic benefits and risks of short-term corticosteroid were investigated in 8 patients with membranous nephropathy and hepatitis B surface antigenaemia. Seven patients presented with nephrotic syndrome, and the remaining patient had significant proteinuria. Their liver function tests were normal on repeated examination. Their sera demonstrated the persistent presence of hepatitis B virus surface antigen and high titres of antibody to hepatitis B virus core antigen. Hepatitis B virus e antigens were present in the sera of 4 patients at initial presentation. Their clinical responses were compared with 7 similar patients previously treated with diuretic therapy alone and acting as historic controls. Short-term corticosteroid (6 months) with stepwise reduction resulted in an early regression of the nephrotic syndrome in 3 patients. Five patients had persistent but reduced proteinuria. Transient liver impairment was observed in 3 patients. Corticosteroid therapy induced transient viral replication with increased serum concentration of hepatitis B virus e antigen and hepatitis B virus DNA. Two of the 7 patients receiving diuretics developed spontaneous remission though apparently later than those receiving corticosteroid. Yet complications such as liver dysfunction and hypertension were not observed in the patients treated with diuretics. Our findings suggest that corticosteroid therapy could be harmful in membranous nephropathy related to hepatitis B surface antigenaemia, as activation of viral replication could occur with corticosteroid therapy.

The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia.

https://www.ajkd.org/article/S0272-6386(89)80019-8/pdf

Hsiang Ju Lin

Papers

The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia.

Isolated presence of antibody to hepatitis B core antigen in dialysis patients: occurrence of subclinical hepatitis?