Evidence-Based Treatment Practice for A Hepatitis B Related Nephritis Patient with Renal Failure_Chinese Journal of Evidence-Based Medicine

Authors：

ZOU Chuan , SU Guobin , LU Fuhua , MAO Wei ,  LIU Xusheng

Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China;

Corresponding?author：

LIU Xusheng, Email: liuxu801@126.com

Keywords：

Hepatitis B related nephritis; Renal failure; Evidence-based clinical practice

DOI：

10.7507/1672-2531.20120058

Video：

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Objective　 By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure.
Methods　 The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software.
Results　 The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced.
Conclusion　 For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.

Citation： ZOU Chuan,SU Guobin,LU Fuhua,MAO Wei,LIU Xusheng. Evidence-Based Treatment Practice for A Hepatitis B Related Nephritis Patient with Renal Failure. Chinese Journal of Evidence-Based Medicine, 2012, 12(3): 360-363. doi: 10.7507/1672-2531.20120058 Copy

1.	Zhou YZ, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. Ann Hepatol, 2011, 10(2): 165-173.
2.	Zhang Y, Zhou J H, Yin X L, et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis. World J Gastroenterol, 2010, 16(6): 770-777.
3.	Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis. Aliment Pharmacol Ther, 2006, 24(5): 781-788.
4.	Zhou JH. [Interpretation of the guidelines for diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 596-598.
5.	[Evidence-based guidelines for diagnosis and treatment of common renal diseases in children (for trial) (V): Guidelines for the diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 592-595.
6.	慢性乙型肝炎特殊患者抗病毒治療專家共識. 中國肝臟病雜志(電子版), 2010(1): 44-51.
7.	Lai F M, Tam J S, Li P K, et al. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol, 1989, 414(3): 279-284.
8.	Lai K N, Tam J S, Lin H J, et al. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron, 1990, 54(1): 12-17.
9.	Sayarlioglu H, Erkoc R, Dogan E, et al. Mycophenolate mofetil use in hepatitis B associated-membranous and membranoproliferative glomerulonephritis induces viral replication. Ann Pharmacother, 2005, 39(3): 573.
10.	Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int, 1990, 37(2): 663-676.
11.	Lai K N, Lai FM. Clinical features and the natural course of hepatitis B virus-related glomerulopathy in adults. Kidney Int Suppl, 1991, 35: S40-S45.
12.	Lin CY, Lo SC. Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract. Kidney Int, 1991, 39(2): 301-306.
13.	Lai KN, Li PK, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med, 1991, 324(21): 1457-1463.
14.	Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int, 1995, 47(1): 225-230.
15.	Steiss JO, Piske-Keyser K, Grone HJ, et al. [Treatment of hepatitis B virus-associated membranous glomerulonephritis with interferon alfa in a 7 year old boy]. Klin Padiatr, 2000, 212(5): 283-286.
16.	Kavukcu S, Basdemir G, Eroglu Y, et al. Interferon treatment in hepatitis B virus-associated membranous glomerulopathy. Pediatr Nephrol, 1995, 9(4): 539-540.
17.	Abbas NA, Pitt MA, Green AT, et al. Successful treatment of hepatitis B virus (HBV)-associated membranoproliferative glomerulonephritis (MPGN) with alpha interferon. Nephrol Dial Transplant, 1999, 14(5): 1272-1275.
18.	Dhiman R K, Kohli HS, Das G, et al. Remission of HBV-related mesangioproliferative glomerulonephritis after interferon therapy. Nephrol Dial Transplant, 1999, 14(1): 176-178.
19.	Lopes N E, Lopes L V, Kirsztajn GM, et al. alpha-Interferon therapy for HBV-related glomerulonephritis. Sao Paulo Med J, 1998, 116(5): 1823-1825.
20.	Chung DR, Yang WS, Kim SB, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol, 1997, 17(2): 112-117.
21.	Miranda-Guardiola F, Fernandez-Llama P, Badia JR, et al. Acute renal failure associated with alpha-interferon therapy for chronic hepatitis B. Nephrol Dial Transplant, 1995, 10(8): 1441-1443.
22.	Shapiro RJ, Steinbrecher UP, Magil A. Remission of nephrotic syndrome of HBV-associated membranous glomerulopathy following treatment with interferon. Am J Nephrol, 1995, 15(4): 343-347.
23.	Ueda T, Gotoh Y, Shiroshita K, et al. [Clinical and histological observation of HBV glomerulonephritis treated with interferon-beta]. Nippon Jinzo Gakkai Shi, 1990, 32(11): 1153-1159.
24.	Kawarazaki N, Sano K, Hayashishita N, et al. [A case of hepatitis B virus carrier state with nephrotic syndrome treated with beta interferon]. Nippon Naika Gakkai Zasshi, 1990, 79(5): 682-683.
25.	Lisker-Melman M, Webb D, Di Bisceglie AM, et al. Glomerulonephritis caused by chronic hepatitis B virus infection: treatment with recombinant human alpha-interferon. Ann Intern Med, 1989, 111(6): 479-483.
26.	Garcia G, Scullard G, Smith C, et al. Preliminary observation of hepatitis B-associated membranous glomerulonephritis treated with leukocyte interferon. Hepatology, 1985, 5(2): 317-320.
27.	Conjeevaram HS, Hoofnagle JH, Austin HA, et al. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology, 1995, 109(2): 540-546.
28.	Tang S, Lai FM, Lui YH, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int, 2005,68(4): 1750-1758.
29.	Wen YK, Chen ML. Remission of hepatitis B virus-associated membranoproliferative glomerulonephritis in a cirrhotic patient after lamivudine therapy. Clin Nephrol, 2006,65(3): 211-215.
30.	Chan TM. Hepatitis B and Renal Disease. Curr Hepat Rep, 2010, 9(2): 99-105.
31.	Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology, 2009, 50(3): 661-662.
32.	Peters MG. Special populations with hepatitis B virus infection. Hepatology, 2009, 49(5 Suppl): S146-S155.

1. Zhou YZ, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. Ann Hepatol, 2011, 10(2): 165-173.
2. Zhang Y, Zhou J H, Yin X L, et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis. World J Gastroenterol, 2010, 16(6): 770-777.
3. Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis. Aliment Pharmacol Ther, 2006, 24(5): 781-788.
4. Zhou JH. [Interpretation of the guidelines for diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 596-598.
5. [Evidence-based guidelines for diagnosis and treatment of common renal diseases in children (for trial) (V): Guidelines for the diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 592-595.
6. 慢性乙型肝炎特殊患者抗病毒治療專家共識. 中國肝臟病雜志(電子版), 2010(1): 44-51.
7. Lai F M, Tam J S, Li P K, et al. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol, 1989, 414(3): 279-284.
8. Lai K N, Tam J S, Lin H J, et al. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron, 1990, 54(1): 12-17.
9. Sayarlioglu H, Erkoc R, Dogan E, et al. Mycophenolate mofetil use in hepatitis B associated-membranous and membranoproliferative glomerulonephritis induces viral replication. Ann Pharmacother, 2005, 39(3): 573.
10. Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int, 1990, 37(2): 663-676.
11. Lai K N, Lai FM. Clinical features and the natural course of hepatitis B virus-related glomerulopathy in adults. Kidney Int Suppl, 1991, 35: S40-S45.
12. Lin CY, Lo SC. Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract. Kidney Int, 1991, 39(2): 301-306.
13. Lai KN, Li PK, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med, 1991, 324(21): 1457-1463.
14. Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int, 1995, 47(1): 225-230.
15. Steiss JO, Piske-Keyser K, Grone HJ, et al. [Treatment of hepatitis B virus-associated membranous glomerulonephritis with interferon alfa in a 7 year old boy]. Klin Padiatr, 2000, 212(5): 283-286.
16. Kavukcu S, Basdemir G, Eroglu Y, et al. Interferon treatment in hepatitis B virus-associated membranous glomerulopathy. Pediatr Nephrol, 1995, 9(4): 539-540.
17. Abbas NA, Pitt MA, Green AT, et al. Successful treatment of hepatitis B virus (HBV)-associated membranoproliferative glomerulonephritis (MPGN) with alpha interferon. Nephrol Dial Transplant, 1999, 14(5): 1272-1275.
18. Dhiman R K, Kohli HS, Das G, et al. Remission of HBV-related mesangioproliferative glomerulonephritis after interferon therapy. Nephrol Dial Transplant, 1999, 14(1): 176-178.
19. Lopes N E, Lopes L V, Kirsztajn GM, et al. alpha-Interferon therapy for HBV-related glomerulonephritis. Sao Paulo Med J, 1998, 116(5): 1823-1825.
20. Chung DR, Yang WS, Kim SB, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol, 1997, 17(2): 112-117.
21. Miranda-Guardiola F, Fernandez-Llama P, Badia JR, et al. Acute renal failure associated with alpha-interferon therapy for chronic hepatitis B. Nephrol Dial Transplant, 1995, 10(8): 1441-1443.
22. Shapiro RJ, Steinbrecher UP, Magil A. Remission of nephrotic syndrome of HBV-associated membranous glomerulopathy following treatment with interferon. Am J Nephrol, 1995, 15(4): 343-347.
23. Ueda T, Gotoh Y, Shiroshita K, et al. [Clinical and histological observation of HBV glomerulonephritis treated with interferon-beta]. Nippon Jinzo Gakkai Shi, 1990, 32(11): 1153-1159.
24. Kawarazaki N, Sano K, Hayashishita N, et al. [A case of hepatitis B virus carrier state with nephrotic syndrome treated with beta interferon]. Nippon Naika Gakkai Zasshi, 1990, 79(5): 682-683.
25. Lisker-Melman M, Webb D, Di Bisceglie AM, et al. Glomerulonephritis caused by chronic hepatitis B virus infection: treatment with recombinant human alpha-interferon. Ann Intern Med, 1989, 111(6): 479-483.
26. Garcia G, Scullard G, Smith C, et al. Preliminary observation of hepatitis B-associated membranous glomerulonephritis treated with leukocyte interferon. Hepatology, 1985, 5(2): 317-320.
27. Conjeevaram HS, Hoofnagle JH, Austin HA, et al. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology, 1995, 109(2): 540-546.
28. Tang S, Lai FM, Lui YH, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int, 2005,68(4): 1750-1758.
29. Wen YK, Chen ML. Remission of hepatitis B virus-associated membranoproliferative glomerulonephritis in a cirrhotic patient after lamivudine therapy. Clin Nephrol, 2006,65(3): 211-215.
30. Chan TM. Hepatitis B and Renal Disease. Curr Hepat Rep, 2010, 9(2): 99-105.
31. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology, 2009, 50(3): 661-662.
32. Peters MG. Special populations with hepatitis B virus infection. Hepatology, 2009, 49(5 Suppl): S146-S155.

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