1/34. alpha-Interferon therapy for HBV-related glomerulonephritis.We report a case of a patient with hepatitis b virus (HBV)-related membranous glomerulonephritis (MGN) who showed improvement after interferon-alpha (IFN-alpha) therapy. A 35-year-old man with nephrotic syndrome and HBV antigens received a 24-week course of IFN-alpha. At the end of therapy there was an elevation in the level of plasma aminotransferase and an increase in proteinuria, which were followed by antigen/antibody seroconversion. This "flare-up" before seroconversion suggests an increase in disease activity in the liver and kidney, demonstrating in vivo HBV involvement in MGN.- - - - - - - - - - ranking = 1keywords = glomerulonephritis (Clic here for more details about this article) |
2/34. Transformation of hepatitis b virus-related membranous glomerulonephritis to crescentic form.We report a case of hepatitis b virus-(HBV) related membranous glomerulonephritis which progressed to crescentic transformation after withdrawal of immunosuppressive treatment. Immunosuppressive therapy probably enhanced HBV replication, and its withdrawal led to a return of immune competence resulting in progression of the glomerulonephritis. Prior screening of all patients for hepatitis B surface antigen, before using immunosuppressive therapy may prevent this complication. The usage of immunosuppressive therapy as a first-line choice in HBV-related glomerulonephritis may result in harmful complications.- - - - - - - - - - ranking = 1.4keywords = glomerulonephritis (Clic here for more details about this article) |
3/34. Waldenstrom's macroglobulinaemia presenting as reticulate purpura and bullae in a patient with hepatitis b virus infection.Cutaneous manifestations of Waldenstrom's macroglobulinaemia (WM) include purpura, ulcers, urticaria, leukocytoclastic vasculitis, and immunobullous dermatoses. No association has been reported previously of WM and hepatitis b virus (HBV) infection. A 40-year-old female HBV carrier was admitted to hospital because of generalized oedema, oliguria, haematuria, hypertension, fever and blood-tinged sputum. Cutaneous manifestations included generalized petechiae, palpable purpura mainly on the legs, multiple necrotic ulcerations and gangrenous changes on the toes, and necrotic, giant confluent reticulate purpura on the trunk surmounted by several tense bullae. Laboratory investigations revealed monoclonal gammopathy of IgM kappa type (6.7 g/L), membranoproliferative glomerulonephritis associated with HBV infection, Bence Jones proteinuria, and an increased number of abnormal plasmacytoid cells in the bone marrow. Pathologic examination demonstrated immune complex-mediated vasculitis with deposits of IgM in the walls of dermal vessels and secondary subepidermal bulla formation. HBV infection may have caused WM or modified the clinical course in this fatal case.- - - - - - - - - - ranking = 0.47763731640699keywords = glomerulonephritis, membranoproliferative, membranoproliferative glomerulonephritis (Clic here for more details about this article) |
4/34. Interferon treatment for hepatitis B-associated membranous glomerulonephritis in two Chinese children.Two Chinese boys, aged 3.5 and 5 years, developed nephrotic syndrome and were chronic carriers of hepatitis b virus surface antigen (HBsAg) and hepatitis b virus e antigen (HBeAg). Renal biopsy showed membranous glomerulonephritis and liver biopsy showed chronic persistent hepatitis. They were given interferon-alpha-2a at a dose of 5 MU/m2 on alternate days for 12 and 16 weeks after 2 years of persistent nephrotic syndrome. Patient 1 showed complete remission and resolution of hepatosplenomegaly, but his serum remained positive for HBsAg, HBeAg and hepatitis b virus dna. Patient 2 showed only a transient clinical response and seroconversion from HBeAg to anti-HBe status. Although not always successful, interferon treatment should be considered in severe persistent nephrotic states, since there is at present no satisfactory treatment for this form of glomerulonephropathy.- - - - - - - - - - ranking = 1keywords = glomerulonephritis (Clic here for more details about this article) |
5/34. Crescentic glomerulonephritis related to hepatitis b virus.Crescentic glomerulonephritis was diagnosed in two chronic hepatitis B surface antigen carriers. In all three biopsies performed, hepatitis B e antigen was found in glomerular capillary tufts. The first patient presented with nephrotic syndrome and acute renal failure. The glomerular pathology revealed crescentic glomerulonephritis with endocapillary proliferation, and she recovered spontaneously with normal renal function over the following 6 mo despite a persistent hepatitis B surface antigenemia. The other patient presented with nephrotic syndrome and normal renal function. hepatitis b virus-related membranous nephropathy was diagnosed on the first biopsy, and he did well on symptomatic treatment for 20 mo. The nephrotic syndrome recurred and subsequently he developed acute renal failure a month following interferon treatment. The repeated biopsy revealed a crescentic glomerulonephritis that was associated with mixed membranous and membranoproliferative glomerulopathies. This patient responded to immunosuppression and plasma exchange with residual impairment of renal function. He has been stable after 18 mo follow-up.- - - - - - - - - - ranking = 1.5497018643298keywords = glomerulonephritis, membranoproliferative (Clic here for more details about this article) |
6/34. lamivudine for nephrotic syndrome related to hepatitis b virus (HBV) infection.A 57-year-old man presented with nephrotic syndrome associated with active HBV infection. liver biopsy showed severe portal and moderate lobular inflammation, patchy necrosis, moderate fibrosis and several "ground glass" cells. Immunofluorescence microscopical view of the renal biopsy showed diffuse granular IgG deposits along the glomerular basement membrane, compatible with MN. As symptomatic therapy with ACE inhibitors did not improve the nephrotic syndrome, lamivudine 100 mg o.d. was initiated. HBV-dna became undetectable after 10 weeks and seroconversion of HBeAg and HBsAg to anti-HBe and anti-HBs occurred after 2 additional months; proteinuria normalized subsequently. This observation documents for the first time in an adult the beneficial effect of lamivudine in glomerulonephritis related to HBV infection with HBV seroconversion and complete remission of the nephrotic syndrome.- - - - - - - - - - ranking = 0.2keywords = glomerulonephritis (Clic here for more details about this article) |
7/34. Acute renal failure in hepatitis b virus-related membranous nephropathy with mesangiocapillary transition and crescentic transformation.We report the first case of hepatitis b virus (HBV)-related membranous nephropathy (MN) that progressed to crescentic transformation superimposed on a mixed membranous and mesangiocapillary glomerulonephritis. The patient developed acute renal failure, which partially responded to pulse methylprednisolone therapy, and subsequently recovered after plasma exchange.- - - - - - - - - - ranking = 0.2keywords = glomerulonephritis (Clic here for more details about this article) |
8/34. Remission of hepatitis B-associated membranous glomerulonephritis in human immunodeficiency virus infection.hepatitis b virus (HBV) infection has been associated with several renal diseases, the most common being membranous glomerulonephritis (MGN). The role of concurrent human immunodeficiency virus (hiv) infection in affecting the course of the renal involvement is largely unknown. We report the case of a hiv-infected adult male with chronic HBV-associated MGN who had complete remission of the nephrotic syndrome associated with spontaneous seroconversion from hepatitis B e antigen (HBeAg)-positive to HBeAg-negative. The present case illustrates that hiv infection does not preclude improvement of chronic HBV infection or an associated membranous nephropathy. Such improvement may be dependent on the ability of the host immune system to clear HBeAg.- - - - - - - - - - ranking = 1keywords = glomerulonephritis (Clic here for more details about this article) |
9/34. Improvement of hepatitis B-associated glomerulonephritis after antiviral combination therapy.A 9-year-old boy with hepatitis B-associated glomerulonephritis and nephrotic syndrome underwent antiviral combination therapy including interferon and acyclovir. Pretreatment evaluation showed that active hepatitis b virus replication with HBsAg, HBeAg, HBV-dna and dna-polymerase had occurred for a period of at least 4 years. Signs of liver disease were minimal; serum amino transferases were normal and liver histology showed chronic persistent hepatitis with positive HBcAg, HBeAg and HBsAg immunofluorescence. A kidney biopsy revealed membranous glomerulonephritis with deposition of HBcAg, HBeAg, IgG, C3, C1q and, on electron microscopy, virus-like particles. After 8 weeks of therapy, active viral replication ceased, HBe seroconversion occurred and the nephrotic syndrome disappeared. One year after treatment, the boy was asymptomatic. No viral markers could be detected in the kidney, but low-grade membranous glomerulonephritis persisted with deposition of C1q, IgG and C3, but not HBeAg, HBsAg or HBcAg. liver histology showed a minimal aspecific portal infiltrate with weak membrane-bound HBsAg immunofluorescence; no HBcAg could be detected. For patients with active viral replication and deposition of HBc, HBe immune complexes in the kidney, antiviral therapy can be beneficial, even in the absence of active liver disease.- - - - - - - - - - ranking = 1.4keywords = glomerulonephritis (Clic here for more details about this article) |
10/34. Improvement of immune-complex nephritis associated with hepatitis B surface antigen excess.A case of hypocomplementemic membranoproliferative glomerulonephritis was studied during remission of nephrosis induced by high doses of corticosteroids. Hepatitis B surface antigen (HBsAg) and immune complexes were detected in serum and glomeruli. Anti-hepatitis-B surface antibody, undetectable in serum by conventional radioimmunoassays was identified in circulating immune complexes (CIC). On two occasions, improvement in renal function coincided paradoxically with an extreme increase in serum HBsAg levels as well as with marked elevation of CIC. We suggest that, as previously observed in animal models of glomerulonephritis, extreme antigen excess may inhibit glomerular deposition of immune complexes.- - - - - - - - - - ranking = 0.67763731640699keywords = glomerulonephritis, membranoproliferative, membranoproliferative glomerulonephritis (Clic here for more details about this article) |
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