The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Pathological Findings of a Renal Biopsy Showing Chronic Hepatitis B in A Patient with Acute Hepatitis A

급성 A형 간염에서 우연히 발견된 만성 B형 간염과 연관된 신조직 소견

  • Jeong, Jae-Jin (Department of Internal Medicine, Sun General Hospital) ;
  • Kim, Goeng-Bae (Department of Internal Medicine, Sun General Hospital) ;
  • Park, Seo (Department of Internal Medicine, Sun General Hospital) ;
  • Yoon, Hyung-Sik (Department of Internal Medicine, Sun General Hospital) ;
  • Seo, Kwang-Sun (Department of Pathology, Chungnam National University College of Medicine) ;
  • Lee, Gye-Sung (Department of Internal Medicine, Sun General Hospital) ;
  • Kang, Hyoun-Mo (Department of Internal Medicine, Sun General Hospital)
  • 정재진 (영훈의료재단 대전 선병원 내과학교실) ;
  • 김굉배 (영훈의료재단 대전 선병원 내과학교실) ;
  • 박설 (영훈의료재단 대전 선병원 내과학교실) ;
  • 윤형식 (영훈의료재단 대전 선병원 내과학교실) ;
  • 서광선 (충남대학교 의과대학 충남대학교병원 병리과) ;
  • 이계성 (영훈의료재단 대전 선병원 내과학교실) ;
  • 강현모 (영훈의료재단 대전 선병원 내과학교실)
  • Published : 2011.01.01
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Abstract

Hepatitis A is usually a self-limited liver disease that is treated conservatively. Acute renal injury complicating acute hepatitis A in the absence of fulminant hepatic failure is rare. We experienced a 33-year-old man who was healthy, and did not know that he was a hepatitis B virus (HBV)carrier with non-fulminant hepatitis A. He developed an acute kidney injury that necessitated dialysis therapy and a renal biopsy. He recovered within about 1 month. Pathologically, the renal biopsy showed acute tubular necrosis. It also showed IgA nephropathy and mesangium proliferation with glomerular nephritis, which are seen in chronic viral hepatitis B. We describe the association of acute hepatitis A with acute kidney injury and report the pathological findings of a renal biopsy related to chronic hepatitis B in an acute hepatitis A patient discovered by chance.

저자들은 비전격성 형태로 발현된 급성 A형 간염으로 인한 급성 신부전을 경험하였다. 환자의 임상 경과와 병리 소견을 알기 위해 실시한 신조직 검사에서 급성 신부전의 특징적인 조직 소견인 급성 신세뇨관 괴사를 확인하였고, 광학현미경 소견에서 IgA신병증 그리고 면역 형광 염색에서 과막증식 사구체 신염을 확인하여 역으로 만성 B형 간염으로 인한 신병증도 함께 진단할 수 있었다. 이후 실시한 혈액 투석으로 신기능이 회복된 예를 경험하였기에 이를 보고하는 바이며 이런 환자에서 특별한 금기가 없는 한 신조직 검사를 실시하는 것이 환자의 임상경과를 알고 치료하는데에 도움이 된다 하겠다.

Keywords

References

  1. Sherlook S, Dooley J. Disease of the Liver and Biliary System. 11th ed. Oxford: Blackwell, 2002.
  2. Kim SH, Yoon HE, Kim YK, et al. Acute hepatitis A-associated acute renal failure in adults. Nephron Clin Pract 2008;109:c127-132. https://doi.org/10.1159/000145455
  3. Geltner D, Naot Y, Zimhoni O, Gorbach S, Bar-Khayim Y. Acute oliguric renal failure complication type A nonfulminant viral hepatitis: a case presentation and review of the literature. J Clin Gastroenterol 1992;14:160-162. https://doi.org/10.1097/00004836-199203000-00019
  4. McCann UG 2nd, Rabito F, Shah M, Nolan CR 3rd, Lee M. Acute renal failure complicating nonfulminant hepatitis A. West J Med 1996;165:308-310.
  5. Faust RL, Pimstone N. Acute renal failure associated with nonfulminant hepatitis A viral infection. West J Gastroenterol 1996;91:369-372.
  6. Lin CC, Chang CH, Lee SH, Chiang SS, Yang AH. Acute renal failure in non-fulminant hepatitis A. Nephrol Dial Transplant 1966;11:2061-2066.
  7. Song KS, Kim MJ, Jang CS, et al. Clinical features of acute viral hepatitis A complicated with acute renal failure. Korean J Hepatol 2007;13:166-173.
  8. 대한의사협회 A형 간염 대책위원회. 의료인 대상 A형 간염 관련 지침안. 서울: Korean Med Association, 2009.
  9. Green J, Beyar R, Bomzon L, Finberg JP, Better OS. Jaundice, the circulation and the kidney. Nephron 1984;37:145-152. https://doi.org/10.1159/000183235
  10. Adas M, Tanakol R, Yarman S, Boztepe H, Ecder T, Alagol F. Acute renal failure associated with nonfulminant hepatitis A virus infection. Ren Fail 2002;24:97-102. https://doi.org/10.1081/JDI-120002665
  11. Lin CC, Chang CH, Lee SH, Chiang SS, Yang AH. Acute renal failure in nonfulminant hepatitis A. Nephrol Dial Transplant 1996;11:2061-2066. https://doi.org/10.1093/oxfordjournals.ndt.a027098
  12. Badr KF, Kelly VE, Rennke HG, Brenner BM. Roles for thromboxane A2 and leukotriens in endotoxin-induced acute renal failure. Kideny Int 1986;30:474-480. https://doi.org/10.1038/ki.1986.210
  13. Baker RJ, Pusey CD. The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant 2004;19:8-11. https://doi.org/10.1093/ndt/gfg464
  14. McGuire BM, Julian BA, Bynon JS Jr, et al. Brief communication: glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med 2006;144:735-741. https://doi.org/10.7326/0003-4819-144-10-200605160-00007
  15. Wang NS, Wu ZL, Zhang YE, Guo MY, Liao LT. Role of hepatitis B virus infection in pathogenesis of IgA nephropathy. World J Gastroenterol 2003;9:2004-2008. https://doi.org/10.3748/wjg.v9.i9.2004
  16. 박문향, 안혜선. B형 간염 바이러스에 동반된 신장병증의 임상 및 병리학적 연구. 대한병리학회지 1992;26:215-228.
  17. Wiggelinkhuizen J, Sinclair-Smith C, Stannard LM, Smuts H. Hepatitis B virus associated membranous glomerulonephritis. Arch Dis Child 1983;58:488-496. https://doi.org/10.1136/adc.58.7.488
  18. Brzosko WJ, Krawczynski K, Nazarewicz T, Morzycka M, Nowoslawski A. Glomerulonephritis associated with hepatitis-B surface antigen immune complexes in children. Lancet 1974;2:477-482.
  19. Han SS, Kim MK, Choi BY, et al. Interstitial nephritis and IgA nephropathy in a patient with acute hepatitis A. Korean J Nephrol 2007;26:748-752.
  20. Lee HW, Chon CY, Park YN, et al. Histopathologic correlation between chronic hepatitis B and nephropathy. Korean J Hepatol 2001;7:413-422.