Viral Infection Associated Membranous Nephropathy: Clinical Presentation and Outcomes

Viral infections can increase the likelihood of an individual developing membranous nephropathy (MN). Limited information is available regarding the treatment approaches for such cases. We conducted a review focusing on hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV)-associated MN.

Our investigation encompassed patient records and cases documented in the literature, utilizing various search engines (PubMed, Scopus, Embase, and Web of Science). We aimed to identify all reported instances of MN associated with HBV, HCV, or HIV infections between 2010 and February 2023 in individuals aged 18 years and above, who underwent PLA2R testing in their serum or kidney biopsy.

We analyzed 63 patients with MN associated with viral infections, comprising 7 patients from our center and 57 from the review, consisting of 43% with HIV, 28.5% with HBV, 17.5% with HCV, and 11% with mixed infections. The average age of these patients was 47 years. Their mean proteinuria, serum albumin, and creatinine levels were 7.5 g/day, 2.3 g/dl, and 1.4 mg/dl, respectively. Two-thirds of these cases were PLA2R-related. Notably, 24% of patients achieved remission solely through antiviral treatment, while nearly 40% attained remission with a combination of antiviral and immunosuppression therapies. Eight patients did not achieve remission despite receiving immunosuppressive therapy and antiviral agents.

The review suggests that using antiviral medications alone or combined with immunosuppressive therapy can lead to substantial remission in patients with viral-associated MN.