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Hepatitis B-related glomerulonephritis and optimization of treatment

Yanjun Liu1, Cuicui Shi1, Jiangao Fan1

  • 1Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Expert Review of Gastroenterology & Hepatology
|January 18, 2020
PubMed

Insights

Hepatitis B virus (HBV)-related glomerulonephritis (HBV-GN) involves immune complex deposition. Antiviral therapies, including nucleoside/nucleotide analogs (NAs) and interferon (IFN), are key treatments, with NAs recommended for first-line therapy.

Area of Science:

  • Nephrology
  • Hepatology
  • Immunology

Background:

  • A strong link exists between hepatitis B virus (HBV) infection and nephropathy.
  • Hepatitis B-related glomerulonephritis (HBV-GN) pathogenesis involves kidney-deposited immune complexes.
  • Clearing HBV antigenemia can improve renal function and reduce proteinuria in HBV-GN patients.

Purpose of the Study:

  • To review the epidemiology, pathogenesis, pathology, diagnosis, and treatment of HBV-GN.
  • To discuss the pros and cons of oral nucleoside/nucleotide analogs (NAs) for HBV treatment.
  • To provide expert opinion on current and emerging therapeutic strategies for HBV-GN.

Main Methods:

  • Literature review of HBV-GN.
  • Analysis of current treatment options for hepatitis B.
  • Discussion of antiviral agents, including interferon (IFN) and nucleoside/nucleotide analogs (NAs).

Main Results:

  • Antiviral agents are the primary treatment for HBV-GN.
  • Interferon (IFN) is suggested for pediatric HBV-GN patients.
  • Novel NAs offer high efficacy and low resistance rates, with entecavir recommended as first-line therapy.
  • Immunosuppression monotherapy, like corticosteroids, is not recommended due to risks of viral reactivation.

Conclusions:

  • Antiviral therapy is crucial for managing HBV-GN.
  • NAs with a high resistance barrier are preferred first-line treatments.
  • IFN may be suitable for specific pediatric cases, while immunosuppression should be avoided.

Keywords:
Antiviral therapyglomerulonephritishepatitis Bimmune compleximmunosuppressive therapy

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