Lamivudine in hepatitis B-associated membranous nephropathy.
BACKGROUND
Although lamivudine is effective for treatment of chronic hepatitis B (HBV) infection, its potential therapeutic impact on HBV-related membranous nephropathy (MN) in adults has not been characterized.


METHODS
We treated 10 HBsAg-positive patients with biopsy-proven MN, elevated serum alanine aminotransferase (ALT), and HBV-DNAemia (group 1), and compared their clinical course with 12 patients diagnosed to have HBV infection, elevated serum ALT, and MN in the pre-lamivudine era (group 2).


RESULTS
Baseline demographic and clinical parameters were not different between the 2 groups. In group 1, lamivudine treatment was associated with significant reduction in proteinuria, increase in serum albumin, normalization of ALT levels, and disappearance of circulating HBV-DNA during the first year. Four (40%) and 6 (60%) patients went into complete remission (proteinuria <0.3 g/d) at 6 and 12 months, respectively. In group 2, significant proteinuria persisted during the first year. One (8.3%) and 3 (25%) patients went into remission. Cumulative 3-year renal survival [using end-stage renal disease (ESRD) as primary end point] was 100% in group 1 and 58% in group 2 (P= 0.024, log rank test). Blood pressure control reached the target of below 130/85 mm Hg in both groups. Lamivudine was well tolerated and not associated with any adverse events. Hepatic decompensation or malignancy was not observed during follow-up in both groups.


CONCLUSIONS
HBV-related MN leads to ESRD in a significant proportion of patients before the advent of antiviral therapy. Lamivudine treatment improves renal outcome in HBV carriers with MN and evidence of liver disease.
Tang
Sydney
S
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China. scwtang@hku.hk
Lai
Fernand Mac-Moune
FM
Lui
Yun Hoi
YH
Tang
Colin S O
CS
Kung
Nelson N S
NN
Ho
Yiu Wing
YW
Chan
Kwok Wah
KW
Leung
Joseph C K
JC
Lai
Kar Neng
KN
D000328:Adult; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000473:pathology / Q000517:prevention & control* / Q000821:virology*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000517:prevention & control / Q000821:virology; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine