Meta-analysis of the efficacy and safety of nucleotide/nucleoside analog monotherapy for hepatitis B virus-associated glomerulonephritis

Abstract

HBV-GN proteinuria remission with elevated serum albumin, decreased HBV replication, and improved HBeAg clearance could be achieved using NA monotherapy. Furthermore, NA monotherapy may protect renal function in HBV-GN patients by preventing Scr elevation.

Efficacy and safety of anti-viral therapy for Hepatitis B virus-associated glomerulonephritis: A meta-analysis

“…Our meta-analysis showed that most patients with HBV-GN were successfully treated with antiviral therapy, and the summary estimate for the OR of proteinuria decrease at the end of therapy was 11.64 (95% CI: 5.17−26.21). Similar results were reported in previous meta analyses [4,6,7,9,10]. Compared with CR, the quantity of PR could not reflect the treatment effects, https://doi.org/10.1371/journal.pone.0227532.g007 so our study focused on total remission (CR+PR) and CR.…”

“…Several meta-analyses [4][5][6][7][8][9][10] have been published regarding the effects of different therapies in HBV-GN patients; three studies [4,6,7] focused on the effects of antiviral treatment on HBV-GN but were completed before 2011. However, previous investigators did not provide details regarding to therapies, such as treatment for patients of different ages, antiviral drug selection or treatment duration.…”

Hypophosphatemia predicts a failure to recover from adefovir‐related renal injury after dose reduction in lamivudine‐resistant hepatitis B patients

“…In addition to dose reduction of ADV or switiching to another antiviral agent if necessary, phosphorus supplementation is also recommended in patients with hypophosphatemia arising from ADV‐related renal tubular injury. Hepatitis B infection occasionally causes HBV‐associated glomerulonephritis, including membranous nephropathy and membranoproliferative glomerulonephritis, and the treatment consists of antiviral therapy including nucleotide analogs . Because ADV treatment resulted in amelioration of liver function and decreases in HBe‐Ag and HBV DNA, it is unlikely that the renal injury noted in patients receiving ADV was due to HBV‐associated glomerulonephritis.…”

“…In contrast, the serum phosphorus levels were significantly higher in patients with >20% eGFR recovery after ADV dose reduction than in those without, while the levels in the cohort with ADV-related renal injury as a whole did not significantly increase after dose reduction. Moreover, serum phosphorus level ≥2.5 mg/dL at dose reduction Table 5 Parameter comparison at the time of adefovir dipivoxil (ADV) dose reduction from 10 mg daily to alternate day administration between patients with and without >20% estimated glomerular filtration rate (eGFR) recovery after dose reduction in 26 was identified as the only significant predictor for >20% eGFR recovery after dose reduction. These data suggest that not all patients with decreased eGFR levels due to ADVrelated renal injury had hypophosphatemia, and the eGFR recovery after ADV dose reduction was not uniform among them, but was less in patients with hypophosphatemia at dose reduction.…”

“…Hepatitis B infection occasionally causes HBVassociated glomerulonephritis, including membranous nephropathy and membranoproliferative glomerulonephritis, and the treatment consists of antiviral therapy including nucleotide analogs. 26,27 Because ADV treatment resulted in amelioration of liver function and decreases in HBe-Ag and HBV DNA, it is unlikely that the renal injury noted in patients receiving ADV was due to HBV-associated glomerulonephritis.…”