The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Experience of Anti-Viral Therapy in Hepatitis B-Associated Membranous Nephropathy, Including Lamivudine-Resistant Strains

  • Sun, In O (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Hong, Yu Ah (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Park, Hoon Suk (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Sun Ryoung (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Chung, Byung Ha (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Park, Cheol Whee (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yang, Chul Woo (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Yong Soo (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Bum Soon (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • Published : 2012.12.01
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Abstract

Background/Aims: Chronic hepatitis B infection is a common cause of secondary membranous nephropathy (MN) in endemic areas. Lamivudine treatment improves renal outcome in patients with hepatitis B virus-associated MN (HBVMN), but prolonged use leads to the emergence of lamivudine-resistant variants. We describe our experience treating lamivudine-resistant and other strains of HBV-MN with new antiviral drugs. Methods: Of the 89 patients biopsied and diagnosed with MN from 1996 to 2011, 10 positive for hepatitis B surface antigen were recruited for this study. We investigated the clinical courses, therapeutic responses, and prognoses of patients with HBV-MN. Results: The incidence of HBV-MN among the original 89 patients was 11.2%. Of these patients, four were treated with supportive care and six with antiviral drugs. One of the four patients treated with supportive care had a spontaneous remission. Four of the six patients treated with antiviral drugs were given lamivudine, and the other two were given entecavir. Two of the four patients treated with lamivudine achieved complete remission with seroconversion (i.e., development of anti-hepatitis B e antigen antibodies), whereas the other two had lamivudine-resistant strains, which were detected at 22 and 23 months after lamivudine treatment, respectively. We added adefovir to the treatment regimen for one of these patients, and for the other patient we substituted clevudine for lamivudine. Both of these patients experienced complete remission, as did the two patients initially treated with entecavir, neither of whom showed resistance to the drug. Conclusions: New nucleoside analogues, such as entecavir, adefovir, and clevudine, can be effective for treatment of HBV-MN, including lamivudine-resistant strains.

Keywords

References

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