Hepatitis B-related glomerulonephritis and optimization of treatment
Yanjun LiuORCID Icon, Cuicui Shi, Jiangao Fan, Baocan Wang & Guangming Li
Pages 113-125 | Received 16 Sep 2019, Accepted 15 Jan 2020, Accepted author version posted online: 17 Jan 2020, Published online: 23 Jan 2020
Introduction: Multiple studies have revealed a strong relationship between the development of nephropathy and hepatitis B virus (HBV) infection. The underlying pathogenesis of hepatitis B-related glomerulonephritis (HBV-GN) involves immune complexes, which can be isolated from kidney tissues. Clearance of HBV antigenemia improves renal impairment and proteinuria in HBV-GN patients.
Areas covered: In this review, we present our current understanding of the epidemiology, pathogenesis, pathology, diagnosis, and treatment of HBV-GN. We discuss the advantages and disadvantages of oral nucleoside/nucleotide analogs (NAs), and the main pharmaceutical treatment for hepatis B.
Expert opinion: Currently, antiviral agents are the main HBV-GN therapeutic agents. Although no randomized controlled clinical trials have compared the efficacy of interferon (IFN) and NA, we suggest IFN treatment for pediatric patients (IFN-α in patients ≥1 year; pegIFN-α in patients ≥3 years) considering treatment duration and absence of resistance. Novel NAs have brought about promising treatment options involving high efficacy viral suppression and low resistance rates. NAs with a high barrier to resistance (e.g. entecavir) are recommended as first-line therapy of HBV-GN. Immunosuppression monotherapy, such as corticosteroids, is of little benefit and potentially harmful to HBV-GN patients due to the possibility of viral reactivation.
KEYWORDS: Antiviral therapy, glomerulonephritis, hepatitis B, immune complex, immunosuppressive therapy
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Article highlights
The most common types of hepatitis B related glomerulonephritis include membranous nephropathy, membranoproliferative glomerulonephritis, and mesangial proliferative glomerulonephritis.
Hepatitis B-related glomerulonephritis predominates in male sex and children.
Regarding the treatment of HBV-GN, antiviral therapy is preferred rather than immunosuppressive therapy. IFN is a reasonable treatment in pediatric patients in consideration of the definite treatment duration and absence of resistance. NAs with a high barrier to resistance, including entecavir and tenofovir alafenamide, are considered the first-line therapy due to high efficacy in viral suppression and low incidence of resistance.
Various studies have proven the efficacy of IFN-α, lamivudine, and entecavir in the treatment of HBV-GN with a considerable rate of disease improvement with proteinuria remission.
The majority of the previous studies present a correlation between hepatitis B e-antigen seroconversion and disease improvement, but this relationship is still under debate.作者: StephenW 时间: 2020-2-21 21:49