Clinical Characteristics and Treatment of Patients with IgA Nephropathy and Hepatitis B Surface Antigen

Abstract

Background: The aim of this study is to investigate the clinical characteristics and our experience of treating patients with IgA nephropathy (IgAN) and IgA nephropathy with hepatitis B surface antigen (HBs-IgAN). Methods: From 1996 to 2011, biopsy-proven IgAN was diagnosed in 477 patients and 22 (4.6%) had hepatitis B surface antigen (HBsAg). Of these, we included 360 patients who had more than 6-month follow-up period, and compared clinical characteristics and renal function decline between the patients with IgAN and HBs-IgAN. Results: Of 360 patients, 22 were classified as HBs-IgAN. There were no differences in the clinical characteristics and renal function decline between idiopathic IgAN and HBs-IgAN (-0.01 vs. -0.17 mL/min per 1.73 m 2 /month, p ¼ 0.319). Of 22 patients with HBs-IgAN, nine had hepatitis B virus (HBV) replication marker (RM), of which six were treated with anti-viral agents. However, there were no differences in renal function decline and urinary protein excretion between patients who did or did not receive anti-viral therapy. Five patients with HBs-IgAN received corticosteroid therapy. Of these, three without HBV RM and one with HBV RM who received entecavir did not exhibit active viral replication, whereas the other patients with HBV RM experienced viral replication after lamivudine was discontinued. Conclusion: There were no differences in the clinical characteristics and prognosis between the patients with IgAN and HBs-IgAN. Further, there were no differences in renal function decline and urinary protein excretion between patients with and without anti-viral therapy. Anti-viral therapy may be considered for treating patients with HBs-IgAN receiving immunosuppressants according to HBV RM.

“Associated” or “Secondary” IgA nephropathy? An outcome analysis

“…Within our cohort of 306 consecutive patients with IgAN diagnosed by kidney biopsy, 58 (20%) concurrently had a disorder reported to be associated with IgAN[8]. These patients had mainly viral infections, liver disease or autoimmune disorders, which is in line with other reports, except a lower frequency of hepatitis B virus infection (6 vs. 20–40%)[5,13,24] and the absence of cases of chronic inflammatory bowel disease[14]. This is probably accounted for by regional epidemiologic characteristics.…”

“…It is debatable whether this difference in outcome requires a change in patient management. It is generally agreed that the management of patients with secondary IgAN should be directed towards the underlying disorders[8], but some patients also receive immunosuppressive agents in addition to conservative treatment[13,15]. Whether some subsets of patients can benefit from additional immunosuppression remains unknown.…”

Secondary IgA nephropathy

“…Asialoglycoprotein receptor on hepatocytes binds desialylated glycoproteins through recognition of glycans with terminal galactose or N-acetylgalactosamine ( Figure 2). [22][23][24] Thus, undergalactosylation of IgA1 alone should not hamper its 27 Viral DNA has been detected in glomeruli and renal tubular epithelial cells. 28 The significance of this finding in terms of pathogenesis of IgAN remains to be determined.…”

Clinical usefulness of kidney biopsy in liver transplant recipients with renal impairment

“…It is well known that some types of GN, especially membranous GN, show significant association with HBV infection [18] . However, three of six cases of GN infected with HBV were IgAN, whose association with HBV infection has not been established in previous reports [19] , [20] . Thus, the large number of IgAN cases in this study may accidently result from a high prevalence of IgAN in Korean society [21] .…”