Hepatitis B-related glomerulonephritis and optimization of treatment

ABSTRACT

Introduction: Multiple studies have revealed a strong relationship between the development of nephropathy and hepatitis B virus (HBV) infection. The underlying pathogenesis of hepatitis B-related glomerulonephritis (HBV-GN) involves immune complexes, which can be isolated from kidney tissues. Clearance of HBV antigenemia improves renal impairment and proteinuria in HBV-GN patients.

Areas covered: In this review, we present our current understanding of the epidemiology, pathogenesis, pathology, diagnosis, and treatment of HBV-GN. We discuss the advantages and disadvantages of oral nucleoside/nucleotide analogs (NAs), and the main pharmaceutical treatment for hepatis B.

Expert opinion: Currently, antiviral agents are the main HBV-GN therapeutic agents. Although no randomized controlled clinical trials have compared the efficacy of interferon (IFN) and NA, we suggest IFN treatment for pediatric patients (IFN-α in patients ≥1 year; pegIFN-α in patients ≥3 years) considering treatment duration and absence of resistance. Novel NAs have brought about promising treatment options involving high efficacy viral suppression and low resistance rates. NAs with a high barrier to resistance (e.g. entecavir) are recommended as first-line therapy of HBV-GN. Immunosuppression monotherapy, such as corticosteroids, is of little benefit and potentially harmful to HBV-GN patients due to the possibility of viral reactivation.

KEYWORDS:

• Antiviral therapy
• glomerulonephritis
• hepatitis B
• immune complex
• immunosuppressive therapy

Article highlights

• The most common types of hepatitis B related glomerulonephritis include membranous nephropathy, membranoproliferative glomerulonephritis, and mesangial proliferative glomerulonephritis.

• Hepatitis B-related glomerulonephritis predominates in male sex and children.

• Regarding the treatment of HBV-GN, antiviral therapy is preferred rather than immunosuppressive therapy. IFN is a reasonable treatment in pediatric patients in consideration of the definite treatment duration and absence of resistance. NAs with a high barrier to resistance, including entecavir and tenofovir alafenamide, are considered the first-line therapy due to high efficacy in viral suppression and low incidence of resistance.

• Various studies have proven the efficacy of IFN-α, lamivudine, and entecavir in the treatment of HBV-GN with a considerable rate of disease improvement with proteinuria remission.

• The majority of the previous studies present a correlation between hepatitis B e-antigen seroconversion and disease improvement, but this relationship is still under debate.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.