Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis: A case report. Issue 2 (January 2019)

• Record Type: Journal Article
• 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
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 98:Issue 2(2019)
• Publication Date: 2019-01
• Subjects: entecavir -- glomerular hypertrophy -- hepatitis B surface antigen -- hepatitis B virus -- membranoproliferative glomerulonephritis -- steroids; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000014014
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: 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.