Lamivudine in Hepatitis B-associated Membranous Nephropathy

Tang, Shaojie; Lai, Fmm; Lui, YH; Tang, Cso; Kung, Nns; Ho, Yi‐Hui; Chan, KW; Leung, Jck; Lai, KN

doi:10.1016/s1561-5413(09)60200-3

Cited by 13 publications

(20 citation statements)

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“…The optimal duration of antiviral therapy for HBV-associated nephropathy has not been determined. Some clinicians 13 propose long-term antiviral treatment in order to avoid relapses after initial remission, whereas others 14 suggest antiviral continuation only in patients with relapses or no remission. Telbivudine may have a theoretical advantage in this setting, as it has been recently reported to have a favorable effect on renal function, 15 but there are no reports on the efficacy of this drug in patients with renal disease, particularly cases under immunosuppression.…”

Section: Hbv-associated Renal Diseasementioning

confidence: 99%

Treatment of hepatitis B in patients with chronic kidney disease

Pipili

Papatheodoridis²

2013

Kidney International

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Although the prevalence of chronic hepatitis B virus (HBV) infection in patients with chronic kidney disease remains low in developed countries, clinicians should be aware of the rationale for treatment in this setting. This patient population presents particular features and various complicating conditions requiring special treatment strategies. Interferon, the standard treatment for HBV infection, has been poorly tolerated by patients with chronic kidney disease, has presented relatively low efficacy, and has posed renal transplant recipients under the risk of acute rejection. The advent of effective nucleos(t)ide analogs (NAs) has offered the opportunity to minimize the consequences of HBV infection in HBV-positive patients with chronic kidney disease. Combination with immunosuppressive agents might be considered in cases of rapid renal function deterioration and/or severe proteinuria. Among the newer NAs, entecavir may be preferred, because of its high potency, high genetic barrier to resistance, and favorable renal safety profile. However, entecavir presented low efficacy in case of lamivudine or telbivudine resistance, and thus tenofovir may be a better option in that setting. All HBsAg-positive candidates should be treated with NAs before renal transplantation in order to maintain undetectable HBV DNA, reduce liver fibrosis, and prevent hepatic decompensation after renal transplantation. This review summarizes updated issues related to treatment of chronic HBV infection in all categories of population with chronic kidney disease (those exhibiting HBV-associated glomerular disease, those treated with hemodialysis, as well as renal transplant candidates, donors, and recipients).

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Section: Hbv-associated Renal Diseasementioning

confidence: 99%

Treatment of hepatitis B in patients with chronic kidney disease

Pipili

Papatheodoridis²

2013

Kidney International

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“…There is evidence that patients with HBVinduced immune-complex mediated disease may have increased rates of responsiveness to interferon therapy or nucleos(t)ide analogues (217)(218)(219)(220)(221)(222)(223)(224)(225). Most cases reports are with lamivudine but withdrawal of antiviral therapy can lead to relapse of nephrotic syndrome and, as noted, long-term lamivudine treatment is limited by the potential emergence of drug-resistant mutations and hepatic flares (221,226). There is one case reported on entecavir therapy for hepatitis B-related membranous nephropathy, which may be an option especially if prolonged treatment courses are required (227).…”

Section: Management Of Hepatitis B-related Renal Diseasementioning

confidence: 99%

Management of Chronic Hepatitis B: Canadian Association for the Study of the Liver Consensus Guidelines

Coffin

Fung

Mang

2012

Canadian Journal of Gastroenterology

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Chronic hepatitis B (CHB) is a dynamic disease that is influenced by host and virological factors. The management of CHB has become more complex with the increasing use of long-term oral nucleos⁄tide analogue antiviral therapies and the availability of novel diagnostic assays. Furthermore, there is often a lack of robust data to guide optimal management such as the selection of therapy, duration of treatment, potential antiviral side effects and the treatment of special populations. In November 2011, the Canadian Liver Foundation and the Canadian Association for the Study of the Liver convened a consensus conference to review the literature and analyze published data, including other international expert guidelines on CHB management. The proceedings of the consensus conference are summarized and provide updated clinical practice guidelines to assist Canadian health care providers in the prevention, diagnosis, assessment and treatment of CHB.

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“…Interferon may lead to complete remission of proteinuria and HBeAg seroconversion, 2 but the side‐effects such as flu‐like symptoms and psychiatric problems were frequently observed. Recently, lamivudine treatment showed a significant decrease in proteinuria and HBV‐DNA clearance in a year, without any side‐effects 3 . Cumulative 3 year renal survival was 100% 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, lamivudine treatment showed a significant decrease in proteinuria and HBV‐DNA clearance in a year, without any side‐effects 3 . Cumulative 3 year renal survival was 100% 3 . However, the incidence of lamivudine resistant‐HBV mutant strain is approximately 20%/year.…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence of lamivudine resistant‐HBV mutant strain is approximately 20%/year. In addition, recurrence of proteinuria after cessation of lamivudine is another problem 3,4 . This is the first report on the clinical effects of entecavir in HBV‐related MN showing HBeAg seroconversion and HBV clearance within 4 months, and subsequent complete remission of proteinuria.…”

Section: Discussionmentioning

confidence: 99%

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