Hepatitis-B virus associated nephropathies: a clinicopathological study in 14 children

Özdamar, Şükrü Oğuz; Güçer, Şafak; Tinaztepe, K

doi:10.1007/s00467-002-0978-z

Cited by 54 publications

(31 citation statements)

References 15 publications

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“…It may be observed that in the mild ascites group, urinary RBP was higher and eGFR was lower compared those in the control group (P<0.01), whereas urinary mAlb, serum urea and serum Cr exhibited no difference compared with the control group (P>0.05), confirming that urinary RBP is a sensitive indicator of early renal damage in liver cirrhosis with ascites. The pathological classification of renal damage during the course of liver cirrhosis is difficult to determine; hepatitis-related IgA nephropathy and glomerular sclerosis are fairly common (28). A previous study including 65 cases with proteinuria >0.5 g/day, microscopic hematuria or renal damage of unknown causes (serum creatinine >1.5 mg/dl) in patients with liver cirrhosis observed lesions of different degrees in glomerular and non-glomerular structures, including renal blood vessels, renal tubules and renal interstitial fibrosis (29).…”

Section: Discussionmentioning

confidence: 99%

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

Xia

et al. 2017

Exp Ther Med

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Abstract. The aim of the present study was to explore the clinical value of urinary retinol-binding protein (RBP) level in the prognosis of cirrhotic ascites by assessment of the RBP levels prior to and following ascites treatment. The levels of urinary RBP, urinary microalbumin (mAlb), serum urea nitrogen (urea) and serum creatinine (Cr), and the estimated glomerular filtration rate (eGFR) were measured in 90 patients with cirrhosis and ascites hospitalized in a single institution between May 2011 and January 2012, and in 30 healthy controls. The levels of urinary mAlb, serum urea and serum Cr were higher in the cirrhotic patients compared with the healthy controls (P<0.05). Urinary RBP levels were significantly higher and eGFR was significantly lower in the liver cirrhosis group compared with the healthy control group (P<0.01). Urinary RBP, urinary mAlb, serum urea and serum Cr increased and eGFR decreased as the severity of the ascites increased (P<0.05). Urinary RBP was significantly higher in patients whose ascites did not respond or was refractory compared with those in whom it subsided (P<0.05), exhibiting a gradual increase over time in the former and a gradual reduction over time in the latter group (P<0.05). Increased urinary RBP and decreased eGFR in the early stage of cirrhosis ascites suggested impaired renal function, which serves a role in the process of ascites formation. These results indicated that urinary RBP is a sensitive indicator of early renal injury in patients with ascites due to cirrhosis and is closely associated with the progression of cirrhotic ascites. IntroductionCirrhosis is a chronic, progressive, diffuse disease caused by a variety of factors, including hepatitis B virus, alcoholic liver disease and autoimmune liver disease (1-3). Liver cirrhosis mortality increased from 1.54% of global mortality in 1980 to 1.95% in 2010 (4). Ascites is a common complication of cirrhosis decompensation. Approximately 50% of patients with compensated cirrhosis develop ascites within a period of 10 years (5). The emergence of ascites predicts a poor prognosis of decompensated cirrhosis, with a mortality of 15% after 1 year and 44% at the 2 year follow-up. (6). In addition, the quality of life of patients with cirrhosis decreases following the formation of ascites and the 5-year survival rate drops to 50% (7). When ascites progress to refractory ascites, if a liver transplant is not conducted, the prognosis worsens and the 2-year survival rate falls to 35-50% (8). Treatment of ascites not only improves the quality of life of patients, but also reduces the risk of progression to spontaneous bacterial peritonitis, which is the most common fatal complication of liver cirrhosis (9). An improved understanding of the pathophysiological mechanism for ascites in patients with liver cirrhosis is necessary to improve patient treatment and to assist the use of targeted therapies.Ascites formation is the result of the combined action of many factors; however, the mechanism underlying the formation of cirrhoti...

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Section: Discussionmentioning

confidence: 99%

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

Xia

et al. 2017

Exp Ther Med

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“…A case of a pediatric patient with HBV-associated IgAN treated with interferon alfa-2a and lamuvidine has been reported to achieve both clinical remission and marked decrease in HBV DNA titer. 18 A study in patients with HBeAg-negative chronic HBV infection showed that either peginterferon monotherapy or combination therapy with lamivudine was more effective than lamivudine monotherapy in reducing HBV DNA levels. 19 However, the addition of lamivudine to peginterferon in this study did not improve posttherapy response rates.…”

Section: Discussionmentioning

confidence: 99%

Complete Remission of Hepatitis B Virus-Associated Nephrotic Syndrome from IgA Nephropathy Following Peginterferon Therapy

2012

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Hepatitis B virus (HBV) infection is a major cause of acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. HBV has also been associated with various common and uncommon glomerular diseases, including IgA nephropathy (IgAN). We report a patient with chronic HBV infection who presented with atypical features of IgAN with management and long-term follow-up. Much of the data on the treatment of HBV-associated glomerular diseases come from patients with membranous nephropathy, whereas the information on treatment of other glomerulopathies remains largely anecdotal. To the best of our knowledge, treatment of an adult patient with HBV-associated nephrotic syndrome from IgAN with pegylated interferon has not been previously reported. Treatment with pegylated interferon alfa-2b in our patient resulted in complete clinical remission of the nephrotic syndrome as well as a dramatic decrease in HBV viral load. Patient continued to remain in clinical remission 5 years after treatment.

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“…Progression of HBV-related MN toward ESRD occurs in approximately 25%-35% of adults compared with a rate of ,5% in children (15). Spontaneous biopsy-proven histologic resolution of MN has been shown in children which has been associated with systemic HBeAg clearance by the age of 4 years (16).…”

Section: Membranous Nephropathymentioning

confidence: 99%

Viral-Associated GN: Hepatitis B and Other Viral Infections

Kupin

2016

CJASN

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By definition, viral-associated GN indicates the direct pathogenic relationship between active viral replication and the development of acute GN. This definition is in sharp contrast to the semantic label and pathophysiologic foundation behind postinfectious GN that uniquely develops only during a period of resolved and absent active infection. The primary example of postinfectious GN are the glomerular lesions described after a pharyngeal or cutaneous streptococcal infection and do not represent the clinical or immunologic pattern seen with viralassociated GN. Hepatitis B (HBV) is the most common chronic viral infection in the world affecting >400 million people which is more than double the prevalence of chronic HIV and hepatitis C carriers combined. In addition, 10%-20% of HBV patients may be coinfected with hepatitis C and 5%-10% will have coinfection with HIV. Being able to distinguish the different types of GN seen with each viral infection is essential for the practicing clinician as each virus requires its own specific antiviral therapy. HBV-induced immune complex disease with renal injury lies on one end of the spectrum of disorders that occurs after a prolonged chronic carrier state. On the opposite end of the spectrum are renal diseases that develop from acute or subacute viral infections. One important glomerular lesion in this category is the association of collapsing FSGS with acute active cytomegalovirus, Epstein-Barr virus, and parvovirus B19 infection. The data supporting or disproving this relationship for each of these viruses will be discussed. A second renal manifestation of acute viral infections often occurs with many different sporadic or epidemic infections such as dengue and hantavirus and can lead to a transient proliferative GN that resolves upon viral clearance. The complex interplay of HBV and all viruses with the immune system provides conceptual lessons on the pathophysiology of immune complex GN that can be applied to all infection-related renal disease and plays an integral role in developing an approach to therapeutic intervention.

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Hepatitis-B virus associated nephropathies: a clinicopathological study in 14 children

Cited by 54 publications

References 15 publications

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

Complete Remission of Hepatitis B Virus-Associated Nephrotic Syndrome from IgA Nephropathy Following Peginterferon Therapy

Viral-Associated GN: Hepatitis B and Other Viral Infections

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