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Complete remission of primary membranous nephropathy following hepatitis E infection
Seiko Takanohashi1, Takuya Sugiura1, Akane Koyano1
1Department of Nephrology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Suruga-Ku, Shizuoka, Shizuoka, 431-3192, Japan.
Abstract:
Primary membranous nephropathy (PMN) is a major cause of nephrotic syndrome in adults. Studies have shown that one-third of PMN cases undergo spontaneous remission, among which are some cases of infection-related complete remission. Herein, we report the case of a 57-year-old man who achieved complete remission of PMN shortly after the onset of acute hepatitis E infection. At the age of 55 years, the patient developed a nephrotic syndrome, and renal biopsy revealed membranous nephropathy, Ehrenreich-Churg stage 1. Treatment with prednisolone (PSL) reduced urinary protein from 7.8 g/gCre to approximately 1 g/gCre but did not lead to complete remission. However, 7 months after starting treatment, he developed an acute hepatitis E infection after consuming wild boar meat. Immediately after the onset of acute hepatitis E, the patient's urinary protein levels decreased to < 0.3 g/gCre. The PSL dose was subsequently reduced and discontinued after 2 years and 8 months, and complete remission was maintained thereafter. We considered that an increase in the number of regulatory T cells (Tregs) caused by acute hepatitis E infection was associated with PMN remission in this patient.
Insights
Primary membranous nephropathy (PMN) can spontaneously remit, sometimes after infections. A hepatitis E infection triggered complete remission in a PMN patient previously unresponsive to steroids, suggesting an immune link.
Area of Science:
- Nephrology
- Immunology
- Infectious Diseases
Background:
- Primary membranous nephropathy (PMN) is a leading cause of adult nephrotic syndrome.
- Spontaneous remission occurs in about one-third of PMN cases, with infection-related remission being a recognized phenomenon.
Observation:
- A 57-year-old male with stage 1 PMN achieved only partial remission with prednisolone (PSL).
- The patient developed acute hepatitis E infection after consuming wild boar meat.
- Following hepatitis E onset, urinary protein levels dramatically decreased, indicating complete remission.
Findings:
- Complete remission of PMN was achieved shortly after the onset of acute hepatitis E infection.
- Steroid treatment (PSL) was eventually discontinued while maintaining remission.
- The remission is hypothesized to be linked to an increase in regulatory T cells (Tregs) induced by the hepatitis E infection.
Implications:
- Hepatitis E infection may play a role in inducing remission of primary membranous nephropathy.
- This case highlights a potential immunomodulatory effect of viral infections on autoimmune kidney diseases.
- Further research into infection-triggered immune responses could offer novel therapeutic strategies for PMN.
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