Membranous Nephropathy Related to Hepatitis B Virus in Adults

Lai, Kar Neng; Li, Philip K.T.; Lui, Siu Fai; Au, Tak Cheong; Tam, John S.; Tong, Kwok Lung; Lai, Fernand Mac‐Moune

doi:10.1056/nejm199105233242103

Cited by 260 publications

(162 citation statements)

References 21 publications

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“…Infective endocarditis, HIV, and HBV and HBC infections are associated with renal pathologic patterns similar to those previously described in heroin users (123)(124)(125)(126)(127)(128)(129)(130)(131)(132)(133)(134)(135)(136)(137). Because reports of heroin-associated nephropathy predated the surveillance of HCV and HIV infection with serologic and virologic tools, it is conceivable that some of the various histologic findings might have been related to the spectrum of viral illnesses that are encountered in injection drug users (3).…”

Section: Historical Perspective Of Renal Disease and Heroin Usesupporting

confidence: 48%

Chronic Nephropathies of Cocaine and Heroin Abuse

Jaffe

Kimmel²

2006

Clinical Journal of the American Society of Nephrology

121

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Renal disease in cocaine and heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis, and rhabdomyolysis. The pathophysiologic basis of cocaine-related renal injury involves renal hemodynamic changes, glomerular matrix synthesis and degradation, and oxidative stress and induction of renal atherogenesis. Heroin is the most commonly abused opiate in the United States. Previous studies identified a spectrum of renal diseases in heroin users. The predominant renal lesion in black heroin users is focal segmental glomerulosclerosis and in white heroin users is membranoproliferative glomerulonephritis. Although the prevalence of heroin use in the United States has increased, the incidence of "heroin nephropathy" has declined. Because reports of heroin nephropathy predated the surveillance of hepatitis C virus and HIV, the varied findings might be related to the spectrum of viral illnesses that are encountered in injection drug users. Socioeconomic conditions, cultural and behavioral practices, or differences in genetic susceptibilities may be more associated with the development of nephropathy in heroin users than the drug's pharmacologic properties. Administration of cocaine in animal models results in nonspecific glomerular, interstitial, and tubular cell lesions, but there is no animal model of heroin-associated renal disease. The heterogeneity of responses that are associated with heroin is not consistent with a single or simple notion of nephropathogenesis. There are no well-designed, prospective, epidemiologic studies to assess the incidence and the prevalence of renal disease in populations of opiate users and to establish the validity of a syndrome such as heroin nephropathy. It is concluded although there is a paucity of evidence to support a heroinassociated nephropathy, the evidence from in vitro cellular and animal studies to support the existence of cocaine-induced renal changes is more convincing.

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Section: Historical Perspective Of Renal Disease and Heroin Usesupporting

confidence: 48%

Chronic Nephropathies of Cocaine and Heroin Abuse

Jaffe

Kimmel²

2006

Clinical Journal of the American Society of Nephrology

121

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“…Hence, the associations between the severity of chronic HBV infection and diabetic complications could not be fully addressed. Second, HBV infection was known to be associated with glomerulonephritis, which might be a confounding factor for the increased risk of ESRD in patients with chronic HBV infection [31]. However, renal biopsy was performed in only a small number of our patients so this question could not be addressed.…”

Section: Discussionmentioning

confidence: 96%

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

et al. 2006

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Aims/hypothesis: We examined the association between chronic hepatitis B virus (HBV) infection and clinical outcomes in a consecutive cohort of Chinese patients with type 2 diabetes. Subjects, materials and methods: Between 1995 and 1999, 2,838 type 2 diabetes patients underwent comprehensive assessments and blood screening for hepatitis B surface antigen (HBsAg). The risk of occurrence of cardiovascular events and end-stage renal disease (defined as need for dialysis, doubling of serum creatinine or serum creatinine ≥500 μmol/l) was compared between HBsAg-positive and HBsAg-negative groups. Results: At baseline, HBV-infected patients (n=286, 10.1%) were younger (51.0±11.5 vs 53.7±12.7 years, p=0.004), had earlier onset of diabetes (51.0±11.5 vs 53.7±12.7 years, p=0.001) and a higher frequency of retinopathy (28 vs 22%, p=0.03) than non-HBV-infected patients. After a median follow-up of 3.5 years (interquartile range: 1.7-5.9 years) and adjustment of age, glycaemic control and other potential confounding factors, HBV-infected patients were more likely to develop end-stage renal disease than non-HBV infected patients (8.7 vs 6.4%) with a hazard ratio of 4.5 (95% CI 1.1-18.6). The difference in the frequency of cardiovascular endpoints was not statistically significant. Conclusions: In Chinese type 2 diabetes patients, chronic HBV infection was associated with increased risk of end-stage renal disease, and this was independent of other potential confounding factors. Early identification of HBV status and close surveillance of renal function are important in patients with type 2 diabetes who are living in areas where HBV is endemic or who are at risk of chronic HBV infection.

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“…HBV-associated nephrotic syndrome due to membranous nephropathy is not uncommon in children, and spontaneous recovery has been reported, which is often associated with seroconversion of HBeAg to anti-HBe [127] . In adults, on the other hand, spontaneous resolution is relatively uncommon and antiviral therapy may be effective [128] . HBV-related MPGN is characterized by the deposition of antigen-antibody complexes in the mesangium and subendothelial space.…”

Section: Renal Diseases Associated With Liver Diseasesmentioning

confidence: 99%