NDT Advance Access originally published online on November 1, 2005
Nephrology Dialysis Transplantation 2006 21(3):828-829; doi:10.1093/ndt/gfi239
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Lamivudine and HBV-associated nephropathy
1 Department of Nephrology and2 Department of Gastroenterology, Pitie-Salpetriere Hospital Paris-France
Email: hassan.izzedine{at}psl.ap-hop-paris.fr
Sir,
Tang and colleagues [1] report that lamivudine treatment improves renal outcome in HBV carriers with membranous nephropathy (MN) and evidence of liver disease. In children with HBV-associated MN, lamivudine has also been anecdotally reported to induce remission of nephrotic syndrome in two case reports [2,3]. We would like to add our experience with lamivudine in one similar case (Table 1).
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Since July 2002, we have treated with lamivudine (100 mg p.o., daily) one HbsAg positive Asian patient with nephrotic syndrome, biopsy proven stage II membranous nephropathy, elevated serum alanine aminotransferase (ALT), and evidence of HBV-DNA. A liver biopsy showed focal lobular and portal inflammation and changes consistent with a mild chronic hepatitis. There was significant reduction of proteinuria from 6 months of starting lamivudine treatment and the patient went into complete remission (proteinuria <0.01 g/24 h) within 1 year. By 3 years, she continued to take lamivudine with a permanent negative proteinuria. HBV DNA levels dropped from 6750 copies/ml pre-treatment to undetectable levels during treatment, at follow-up 12 months on lamivudine. Liver function tests remain normal. Lamivudine was well tolerated and not associated with any adverse events that required dosage adjustment or drug discontinuation.
Lamivudine treatment has been successful in adults with HBV-associated polyarteritis nodosa [4], and in combination with other antiviral agents to treat HIV-associated nephrotic syndrome [5]. In HBVAN, the duration of lamivudine therapy remains an unresolved issue, notably in Asian patients, as emerging data show that disease progression can continue even after anti-HBe seroconversion in this population [6]. Indeed, one patient described by Tang et al. suffered a relapse of nephrosis after 2 years of complete remission when treatment was withdrawn [1]. Thus, it is reasonable to continue lamivudine treatment for as long as possible after initial remission.
We show that lamivudine significantly improves the clinical outcome of HBV-related MN.
Conflict of interest statement. None declared.
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References |
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 Top References |
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- Tang S, Lai FMcM, Lui YH et al. Lamivudine in hepatitis B–associated membranous nephropathy. Kidney Int 2005; 68: 1750–1758[CrossRef][ISI][Medline]
- Connor FL, Rosenberg AR, Kennedy SE, Bohane TD. HBV associated nephrotic syndrome: Resolution with oral lamivudine. Arch Dis Child 2003; 88: 446–449
[Abstract/Free Full Text] - Filler G, Feber J, Weiler G, Le Saux N. Another case of HBV associated membranous glomerulonephritis resolving on lamivudine. Arch Dis Child 2003; 88: 460
[Free Full Text] - Gupta S, Piraka C, Jaffe M. Lamivudine in the treatment of polyarteritis nodosa associated with acute hepatitis B. N Engl J Med 2001; 344: 1645–1646
[Free Full Text] - Viani RM, Dankner WM, Muelenaer PA et al. Resolution of HIV-associated nephrotic syndrome with highly active antiretroviral therapy delivered by gastrostomy tube. Pediatrics 1999; 104: 1394–1396
[Abstract/Free Full Text] - Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003; 362: 2089–2094[CrossRef][ISI][Medline]
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