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Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report
RATIONALE: Adult-onset hepatitis B virus-associated membranoproliferative glomerulonephritis (HBV-MPGN) is generally refractory, and an effective treatment for this condition has not been established. The indications for steroids in HBV-MPGN are an important clinical concern. PATIENT CONCERNS: A 28-...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336600/ https://www.ncbi.nlm.nih.gov/pubmed/30633192 http://dx.doi.org/10.1097/MD.0000000000014014 |
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author | Kataoka, Hiroshi Mochizuki, Toshio Akihisa, Taro Kawasoe, Kentaro Kawachi, Keiko Makabe, Shiho Sawada, Anri Manabe, Shun Sato, Masayo Amemiya, Nobuyuki Mitobe, Michihiro Akanuma, Takafumi Ito, Yasuko Inoue, Takahiro Suzuki, Tomo Matsui, Katsuomi Moriyama, Takahito Horita, Shigeru Ohara, Mamiko Honda, Kazuho Nitta, Kosaku |
author_facet | Kataoka, Hiroshi Mochizuki, Toshio Akihisa, Taro Kawasoe, Kentaro Kawachi, Keiko Makabe, Shiho Sawada, Anri Manabe, Shun Sato, Masayo Amemiya, Nobuyuki Mitobe, Michihiro Akanuma, Takafumi Ito, Yasuko Inoue, Takahiro Suzuki, Tomo Matsui, Katsuomi Moriyama, Takahito Horita, Shigeru Ohara, Mamiko Honda, Kazuho Nitta, Kosaku |
author_sort | Kataoka, Hiroshi |
collection | PubMed |
description | RATIONALE: Adult-onset hepatitis B virus-associated membranoproliferative glomerulonephritis (HBV-MPGN) is generally refractory, and an effective treatment for this condition has not been established. The indications for steroids in HBV-MPGN are an important clinical concern. PATIENT CONCERNS: A 28-year-old woman with a chronic hepatitis B virus infection developed nephrotic syndrome in her second month of pregnancy, with urinary protein levels of 3 to 10 g/d that continued into her postpartum period. She was a carrier of HBV with HBeAg seroconversion. As her renal impairment could have been a result of pregnancy, we observed her for 10 months postpartum without any intervention. However, spontaneous remission after childbirth was not achieved and urine protein levels were sustained at 1 to 3 g/d. About 10 months after delivery, elevated serum liver enzyme levels were observed. DIAGNOSIS: Biopsies showed MPGN, with deposition of hepatitis B antigen in the glomeruli, and chronic B-type hepatitis with a severity grade of A1F0. She was diagnosed with HBV-MPGN. INTERVENTIONS: The patient was started on entecavir 0.5 mg/d in March 2008. Within 1 month, serum HBV DNA became undetectable; within 3 months, her alanine aminotransferase levels normalized. However, urinary protein excretion did not decrease to <2 g/d. On a second renal biopsy, performed 7 months after entecavir treatment, proliferative lesions of the glomeruli were observed; therefore, prednisolone was started at an initial dose of 30 mg/d. OUTCOMES: Her proteinuria improved immediately and prednisolone was tapered over 10 months. A third renal biopsy showed a remarkable resolution of HBV-MPGN, with a significant decrease in mesangial proliferation and immune complex deposition. HBV reactivation was not observed during the prednisolone treatment. LESSONS: Additional prednisolone therapy in combination with antiviral therapy should be considered for refractory HBV-MPGN, with sufficient care taken regarding HBV reactivation. |
format | Online Article Text |
id | pubmed-6336600 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-63366002019-01-24 Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report Kataoka, Hiroshi Mochizuki, Toshio Akihisa, Taro Kawasoe, Kentaro Kawachi, Keiko Makabe, Shiho Sawada, Anri Manabe, Shun Sato, Masayo Amemiya, Nobuyuki Mitobe, Michihiro Akanuma, Takafumi Ito, Yasuko Inoue, Takahiro Suzuki, Tomo Matsui, Katsuomi Moriyama, Takahito Horita, Shigeru Ohara, Mamiko Honda, Kazuho Nitta, Kosaku Medicine (Baltimore) Research Article RATIONALE: Adult-onset hepatitis B virus-associated membranoproliferative glomerulonephritis (HBV-MPGN) is generally refractory, and an effective treatment for this condition has not been established. The indications for steroids in HBV-MPGN are an important clinical concern. PATIENT CONCERNS: A 28-year-old woman with a chronic hepatitis B virus infection developed nephrotic syndrome in her second month of pregnancy, with urinary protein levels of 3 to 10 g/d that continued into her postpartum period. She was a carrier of HBV with HBeAg seroconversion. As her renal impairment could have been a result of pregnancy, we observed her for 10 months postpartum without any intervention. However, spontaneous remission after childbirth was not achieved and urine protein levels were sustained at 1 to 3 g/d. About 10 months after delivery, elevated serum liver enzyme levels were observed. DIAGNOSIS: Biopsies showed MPGN, with deposition of hepatitis B antigen in the glomeruli, and chronic B-type hepatitis with a severity grade of A1F0. She was diagnosed with HBV-MPGN. INTERVENTIONS: The patient was started on entecavir 0.5 mg/d in March 2008. Within 1 month, serum HBV DNA became undetectable; within 3 months, her alanine aminotransferase levels normalized. However, urinary protein excretion did not decrease to <2 g/d. On a second renal biopsy, performed 7 months after entecavir treatment, proliferative lesions of the glomeruli were observed; therefore, prednisolone was started at an initial dose of 30 mg/d. OUTCOMES: Her proteinuria improved immediately and prednisolone was tapered over 10 months. A third renal biopsy showed a remarkable resolution of HBV-MPGN, with a significant decrease in mesangial proliferation and immune complex deposition. HBV reactivation was not observed during the prednisolone treatment. LESSONS: Additional prednisolone therapy in combination with antiviral therapy should be considered for refractory HBV-MPGN, with sufficient care taken regarding HBV reactivation. Wolters Kluwer Health 2019-01-11 /pmc/articles/PMC6336600/ /pubmed/30633192 http://dx.doi.org/10.1097/MD.0000000000014014 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | Research Article Kataoka, Hiroshi Mochizuki, Toshio Akihisa, Taro Kawasoe, Kentaro Kawachi, Keiko Makabe, Shiho Sawada, Anri Manabe, Shun Sato, Masayo Amemiya, Nobuyuki Mitobe, Michihiro Akanuma, Takafumi Ito, Yasuko Inoue, Takahiro Suzuki, Tomo Matsui, Katsuomi Moriyama, Takahito Horita, Shigeru Ohara, Mamiko Honda, Kazuho Nitta, Kosaku Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title | Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title_full | Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title_fullStr | Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title_full_unstemmed | Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title_short | Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report |
title_sort | successful entecavir plus prednisolone treatment for hepatitis b virus-associated membranoproliferative glomerulonephritis: a case report |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336600/ https://www.ncbi.nlm.nih.gov/pubmed/30633192 http://dx.doi.org/10.1097/MD.0000000000014014 |
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