Abstract
Although the clinical benefits of antiviral treatment in the management of membranous nephropathy (MN) in patients with chronic hepatitis B virus (HBV) infection have been suggested, it should be evaluated more carefully. In this report, we present two cases with quiescent HBV who were administered lamivudine for either the initial treatment of MN or to control the reactivation of HBV during treatment with corticosteroids. No clinical benefit of lamivudine as an initial treatment was observed in one patient, which obliged us to commence administration of prednisolone (PSL). On the other hand, lamivudine seemed to play a pivotal role in the remission of an acute exacerbation of hepatitis B during treatment with PSL and mizoribine in the other patient. These two patients seemed to tolerate administration of PSL with or without an immunosuppressive agent well, since gradual and prompt improvements of nephrotic status were confirmed within a few months, thus suggesting the potential benefit of steroid treatment. There is little consensus regarding the optimal choice of steroids and immunosuppressants for the treatment of MN with chronic HBV infection, due to the potential for stimulation of viral replication and precipitation of hepatic flares. Our observations, however, suggest that treatment with PSL still should be reserved for quiescent HBV carriers with MN. Further studies will be required to determine the optimal timing and appropriate duration of antiviral treatment in such patients requiring long-term immunosuppression.
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References
Schwartz MM. Membranous nephropathy. In: Jennete JC, Olson JL, Schwartz MM, Silvia FG, editors. Heptinstall’s pathology of the kidney. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 205–51.
Ponticelli C. Membranous nephropathy. J Nephrol. 2007;20:268–87.
Lai KN, Tam JS, Lin HJ, Lai FMM. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron. 1990;54:12–7.
Tang S, Lai FMM, Lui YH, Tang CCO, Kung NNS, Ho YW, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int. 2005;68:1750–8.
Kobayashi T, Ando Y, Umino T, Miyata Y, Muto S, Hironaka Y, et al. Complete remission of minimal-change nephrotic syndrome induced by apheresis monotherapy. Clin Nephrol. 2006;65:423–6.
Nishioka Y, Horita Y, Tadokoro M, Taura K, Suyama N, Miyazaki M, et al. Changing mizoribine administration from three divided dose to one single dose induced remission of relapsed membranous nephropathy. Nephrol Dial Transplant. 2006;21:2337–8.
Bhimma R, Coovadia HM. Hepatitis B virus-associated nephropathy. Am J Nephrol. 2004;24:198–211.
Chuang TW, Hung CH, Huang SC, Lee CM. Complete remission of nephrotic syndrome of hepatitis B virus-associated membranous glomerulopathy after lamivudine monotherapy. J Formos Med Assoc. 2007;106:869–73.
Calabrese LH, Zein NN, Vassilopoulos D. Hepatitis B virus (HBV) reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies. Ann Rheum Dis. 2006;65:983–9.
Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with haematological malignancies. Br J Haematol. 2007;136:699–712.
Lai KN, Li PKT, Lui SF, Au TC, Tam JSL, Tong KL, et al. Membranous nephropathy related to hepatitis B virus in adults. N Eng J Med. 1991;324:1457–63.
Chou CK, Wang LH, Lin HM, Chi CW. Glucocorticoid stimulates hepatitis B viral gene expression in cultured human hepatoma cells. Hepatology. 1992;16:13–8.
Gan SI, Devlin SM, Scott-Douglas NW, Burak KW. Lamivudine for the treatment of membranous glomerulopathy secondary to chronic hepatitis B infection. Can J Gastroenterol. 2005;19:625–9.
Okuse C, Yotsuyanagi H, Yamada H, Ikeda H, Takahashi H, Suzuki M, et al. Successful treatment of hepatitis B virus associated membranous nephropathy with lamivudine. Clin Nephrol. 2006;65:53–6.
Kannaan N, Horsmans Y, Goffin E. Lamivudine for nephrotic syndrome related to hepatitis B virus (HBV) infection. Clin Nephrol. 2006;65:208–10.
Mesquita M, Lasser L, Langlet P. Long-term (7-year-) treatment with lamivudine monotherapy in HBV-associated glomerulonephritis. Clin Nephrol. 2008;70:69–71.
Masuda T, Akimoto T, Ando Y, Kobayashi T, Meguro D, Muto S, et al. Changes in the urinary excretion of β2-microglobulin (β2MG) and N-acetyl- β-D-glucosaminidase (NAG) during treatment for lupus nephritis. Intern Med. 2008;47:287–90.
Lok ASF, McMahon BJ. Chronic hepatitis B. Hepatology. 2007;45:507–39.
Idilman R, Arat M, Soydan E, Törüner M, Soykan I, Akubulut H, et al. Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies. J Viral Hepatitis. 2004;11:141–7.
Perma A, Chieppati A, Zamora J, Giuliano GA, Braun N, Remuzzi G. Immunosuppressive treatment for idiopathic membranous nephropathy: a systematic review. Am J Kidney Dis. 2004;44:385–401.
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Akimoto, T., Otake, T., Tanaka, A. et al. Steroid treatment in patients with membranous nephropathy and hepatitis B virus surface antigenemia: a report of two cases. Clin Exp Nephrol 15, 289–293 (2011). https://doi.org/10.1007/s10157-010-0391-z
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DOI: https://doi.org/10.1007/s10157-010-0391-z