Steroid treatment in patients with membranous nephropathy and hepatitis B virus surface antigenemia: a report of two cases

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http://www.springerlink.com/content/m670380174mq7657/

Medicine Clinical and Experimental Nephrology

DOI: 10.1007/s10157-010-0391-zOnline First™

Case Report

Steroid treatment in patients with membranous nephropathy and hepatitis B virus

surface antigenemia: a report of two cases

Tetsu Akimoto, Toshiya Otake, Akira Tanaka, Hideaki Takahashi, Toshihiko

Higashizawa, Makoto Inoue, Katsuhiko Nishino, Osamu Saito, Norio Isoda and

Shigeaki Muto, et al

Abstract

Although the clinical benefits of antiviral treatment in the management of

membranous nephropathy (MN) in patients with chronic hepatitis B virus (HBV)

infection have been suggested, it should be evaluated more carefully. In this

report, we present two cases with quiescent HBV who were administered lamivudine

for either the initial treatment of MN or to control the reactivation of HBV

during treatment with corticosteroids. No clinical benefit of lamivudine as an

initial treatment was observed in one patient, which obliged us to commence

administration of prednisolone (PSL). On the other hand, lamivudine seemed to

play a pivotal role in the remission of an acute exacerbation of hepatitis B

during treatment with PSL and mizoribine in the other patient. These two

patients seemed to tolerate administration of PSL with or without an

immunosuppressive agent well, since gradual and prompt improvements of nephrotic

status were confirmed within a few months, thus suggesting the potential benefit

of steroid treatment. There is little consensus regarding the optimal choice of

steroids and immunosuppressants for the treatment of MN with chronic HBV

infection, due to the potential for stimulation of viral replication and

precipitation of hepatic flares. Our observations, however, suggest that

treatment with PSL still should be reserved for quiescent HBV carriers with MN.

Further studies will be required to determine the optimal timing and appropriate

duration of antiviral treatment in such patients requiring long-term

immunosuppression.

[Guest guest]

http://www.springerlink.com/content/m670380174mq7657/

Medicine Clinical and Experimental Nephrology

DOI: 10.1007/s10157-010-0391-zOnline First™

Case Report

Steroid treatment in patients with membranous nephropathy and hepatitis B virus

surface antigenemia: a report of two cases

Tetsu Akimoto, Toshiya Otake, Akira Tanaka, Hideaki Takahashi, Toshihiko

Higashizawa, Makoto Inoue, Katsuhiko Nishino, Osamu Saito, Norio Isoda and

Shigeaki Muto, et al

Abstract

Although the clinical benefits of antiviral treatment in the management of

membranous nephropathy (MN) in patients with chronic hepatitis B virus (HBV)

infection have been suggested, it should be evaluated more carefully. In this

report, we present two cases with quiescent HBV who were administered lamivudine

for either the initial treatment of MN or to control the reactivation of HBV

during treatment with corticosteroids. No clinical benefit of lamivudine as an

initial treatment was observed in one patient, which obliged us to commence

administration of prednisolone (PSL). On the other hand, lamivudine seemed to

play a pivotal role in the remission of an acute exacerbation of hepatitis B

during treatment with PSL and mizoribine in the other patient. These two

patients seemed to tolerate administration of PSL with or without an

immunosuppressive agent well, since gradual and prompt improvements of nephrotic

status were confirmed within a few months, thus suggesting the potential benefit

of steroid treatment. There is little consensus regarding the optimal choice of

steroids and immunosuppressants for the treatment of MN with chronic HBV

infection, due to the potential for stimulation of viral replication and

precipitation of hepatic flares. Our observations, however, suggest that

treatment with PSL still should be reserved for quiescent HBV carriers with MN.

Further studies will be required to determine the optimal timing and appropriate

duration of antiviral treatment in such patients requiring long-term

immunosuppression.