Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report

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. A 28-year-old woman with a chronic...

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Published in:Medicine (Baltimore) 2019-01, Vol.98 (2), p.e14014-e14014
Main Authors: 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
Format: Article
Language:English
Subjects:
Adult
Antiviral Agents - therapeutic use
Clinical Case Report
Female
Glomerulonephritis, Membranoproliferative - drug therapy
Glomerulonephritis, Membranoproliferative - etiology
Glomerulonephritis, Membranoproliferative - pathology
Glomerulonephritis, Membranoproliferative - virology
Guanine - analogs & derivatives
Guanine - therapeutic use
Hepatitis B virus
Hepatitis B, Chronic - complications
Hepatitis B, Chronic - drug therapy
Hepatitis B, Chronic - pathology
Humans
Prednisolone - therapeutic use
Pregnancy
Pregnancy Complications, Infectious
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Summary: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. 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. 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. 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
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000014014