Cryoglobulinemic glomerulonephritis in chronic hepatitis B infection

Abstract

Hepatitis B virus (HBV) infection is an uncommon cause of cryoglobulinemia. Renal cryoglobulinemia has been rarely reported in the setting of chronic hepatitis B infection. We describe a case of chronic hepatitis B infection with cryoglobulinemic glomerulonephritis (Gn) and provide information about the treatment and the evolution over a 30-month follow-up. A 41-year-old woman with chronic hepatitis B infection developed nephrotic syndrome and acute renal failure; other investigations revealed type 2 cryoglobulinemia; HBV DNA was detected in the cryoprecipitate. Renal biopsy showed findings of cryoglobulinemic Gn. She was given lamivudine, corticosteroids, plasma exchange, and mycophenolate mofetil. The renal function improved, nephrotic syndrome remitted, and HBV DNA became undetectable; there was no compromise of the liver function.

Clinical and morphologic spectrum of renal involvement in patients with HBV‐associated cryoglobulinaemia

“…Therefore, the treatment of HBV‐related MC mainly includes antiviral . Whenever HBV‐related MC glomerulonephritis is associated with nephrotic syndrome and/or rapidly renal insufficiency, it has been suggested to use immunosuppressive therapy and plasma exchange . Because of the efficacy of anti‐CD20 monoclonal antibody in HCV‐related MC, it is reasonable to anticipate that anti‐CD20 antibody would be an option in HBV‐related MC.…”

“…7 Renal involvement in patients with MC related to HBV has been poorly described, with only a few cases reported, and the optimal treatment is unclear. [8][9][10] Therefore, we must pay attention to MC patients related to HBV infection in China. The aim of this retrospective study was to investigate the clinical features and renal biopsy findings in a small group of patients with MC glomerulonephritis and evidence of hepatitis B virus infection.…”

“…However, in the mainland of China, lower prevalence rates of HCV infection (0.43%) have been reported; on the other hand, where HBV infection is endemic in China; the HBsAg carrier rate among aged 1–60 was 7.18% in China by a national survey in 2006 . Renal involvement in patients with MC related to HBV has been poorly described, with only a few cases reported, and the optimal treatment is unclear . Therefore, we must pay attention to MC patients related to HBV infection in China.…”

Interleukin (IL)-10 Gene Polymorphisms Are Associated with Type 2 Diabetes With and Without Nephropathy: A Study of Patients from the Southeast Region of Iran

“…Consent forms were filled out by both patients and controls prior to blood collection. Previous studies showed that some factors such as infections [20][21][22], allergic conditions [23], and smoking [24,25] were considered as bias factors in diabetes and nephropathy; hence, patients with these bias factors were eliminated from the study using a questionnaire.…”

Spectrum of hepatitis B and renal involvement

“…The histological deposition of circulating antigen‐antibody complexes in the mesangium and subendothelial space characterizes the MPGN associated with HBV. (Figure ) Compared with hepatitis C infection, HBV infection is a rare cause of mixed cryoglobulinaemia, which can be associated with MPGN …”