title: Experience of anti-viral therapy in hepatitis B-associated membranous nephropathy, including Lamivudine-resistant strains.
abstract: OBJECTIVE
  Chronic hepatitis B infection is a common cause of secondary membranous nephropathy (MN) in endemic areas. Lamivudine treatment improves renal outcome in patients with hepatitis B virus-associated MN (HBV-MN), but prolonged use leads to the emergence of lamivudine-resistant variants. We describe our experience treating lamivudine-resistant and other strains of HBV-MN with new antiviral drugs.
  
  
  METHODS
  Of the 89 patients biopsied and diagnosed with MN from 1996 to 2011, 10 positive for hepatitis B surface antigen were recruited for this study. We investigated the clinical courses, therapeutic responses, and prognoses of patients with HBV-MN.
  
  
  RESULTS
  The incidence of HBV-MN among the original 89 patients was 11.2%. Of these patients, four were treated with supportive care and six with antiviral drugs. One of the four patients treated with supportive care had a spontaneous remission. Four of the six patients treated with antiviral drugs were given lamivudine, and the other two were given entecavir. Two of the four patients treated with lamivudine achieved complete remission with seroconversion (i.e., development of anti-hepatitis B e antigen antibodies), whereas the other two had lamivudine-resistant strains, which were detected at 22 and 23 months after lamivudine treatment, respectively. We added adefovir to the treatment regimen for one of these patients, and for the other patient we substituted clevudine for lamivudine. Both of these patients experienced complete remission, as did the two patients initially treated with entecavir, neither of whom showed resistance to the drug.
  
  
  CONCLUSIONS
  New nucleoside analogues, such as entecavir, adefovir, and clevudine, can be effective for treatment of HBV-MN, including lamivudine-resistant strains.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: In O
authors.initials: IO
authors.lastname: Sun
authors.forename: Yu Ah
authors.initials: YA
authors.lastname: Hong
authors.forename: Hoon Suk
authors.initials: HS
authors.lastname: Park
authors.forename: Sun Ryoung
authors.initials: SR
authors.lastname: Choi
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Cheol Whee
authors.initials: CW
authors.lastname: Park
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001086:Arabinofuranosyluracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000209:etiology*; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; D001086:Arabinofuranosyluracil; C413685:entecavir; D006147:Guanine; C053001:adefovir; C034935:clevudine; D000225:Adenine