Treatment of Hepatitis B Virus Associated Glomerulonephritis with Recombinant Human Alpha Interferon

Abstract

To evaluate the therapeutic effect of recombinant human α-interferon (α-IFN) on hepatitis B virus associated glomerulonephritis (HBV-GN) and the relationship between the seroconversion of viral antigens and the change of pro-teinuria, the hepatitis B viral markers and urinary protein were monitored during α-IFN treatment in 8 male adult patients who (1) were positive in serum HBsAg and HBeAg, (2) had chronic hepatitis, (3) had persistent proteinuria > 1 g/day, and (4) showed glomerulonephritis on kidney biopsy, α-IFN was given at a dose of 3 million units, subcutaneously, three times a week for 6 months. Kidney biopsy specimens showed membranoproliferative glomerulonephritis (MPGN) in 4 patients, mesangial proliferative glomerulonephritis (MesPGN) in 2, and membranous glomerulonephritis (MGN) in 2 patients. Seven of the 8 patients received a 6-month course of α-IFN therapy; 1 patient with MGN quitted therapy 2 months after the initial dose because of side effects. In 5 of the 7 patients who received a 6-month therapy, serum HBeAg disappeared, and anti-HBe appeared during the therapy. In 2 of these 5 patients, HBeAg reappeared, in 1 during α-IFN therapy and in 1 9 months after the last dose of α-IFN. The hepatitis B viral markers of the patient who received a 2-month therapy did not change. HBs antigenemia persisted in all patients. In all 4 patients with MPGN, serum HBeAg was transiently or persistently converted to negative, but the proteinuria persisted. Both patients with MesPGN showed remission of proteinuria; however, only 1 patient had seroconversion of HBeAg. In 2 patients with MGN, proteinuria persisted. In conclusion, α-IFN at the doses given was not effective in MPGN type of HBV-GN. Improvement of proteinuria was achieved in MesPGN patients without disappearance of HBs antigenemia which is the finding against the possible role of HBsAg in the pathogenesis of this type of HBV-GN.

Treatment of hepatitis B virus-associated glomerulonephritis: A meta-analysis

“…Antiviral therapy has been recommended in many studies for HBV-GN since it can effectively inhibit HBV replication and attenuate proteinuria [9,[25][26][27][28][29][30][31][32][33] . Our results demonstrated that antiviral therapy could significantly improve the remission rate of proteinuria, the clearance rate of HBeAg, and renal progression.…”

“…and even immunosuppressive agents like mycophenolate mofetil, leflunomide [7,8] . It has been shown that antiviral therapy can promote the clearance of HBV and improve the coexisting renal disease [3] , but the efficacy of interferon on HBV-GN has not been confirmed [9,10] . Moreover, interferon therapy is not as successful for HBV-GN in children as for HBV-GN in adults [3] .…”

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

“…Treatment of HBV-associated glomerulopathy remains controversial [9,17,18,19,20,21]. It is claimed that steroids might induce the replication of HBV and prolong the persistence of liver disease or lead to acute hepatic decompensation [21,22].…”

“…It has also been reported that newly diagnosed childhood nephrotic syndrome with HBs antigenemia is not a contraindication for the use of corticosteroid treatment in a slow tapering regimen combined with interferon therapy and close clinical monitoring [24]. There have been conflicting reports of interferon treatment alone of hepatitis B-associated glomerulonephritides [17,18,19,20]. Although there have been no large series suggesting a definite beneficial effect on HBVassociated nephropathy, a small group of patients may respond well to this treatment [20].…”

Hepatitis B and Renal Disease

“…Treatment with interferon [14, 18–25] or lamivudine [17, 26–28] has been reported to lead to a reduction of proteinuria in patients, mostly children, with HBV-related membranous nephropathy.…”