Combination therapy with lamivudine and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for hepatitis B virus-associated glomerulonephritis with mild to moderate proteinuria: a clinical review of 38 cases.Int Urol Nephrol. 2017 Jun; 49(6):1049-1056.IU
The treatment of HBV-associated glomerulonephritis (HBV-GN) is still a challenge in clinical practice now. The objective of this study was to report the pathological characteristics of HBV-GN presenting with mild to moderate proteinuria and to evaluate the therapeutic efficacy of lamivudine (LAM) in combination with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) as compared to ACEI/ARB monotherapy.
We conducted a retrospective observational study in HBV-GN patients between 2005 and 2014. The patients were classified into two groups: Group 1 included patients treated with LAM plus ACEI/ARB (n = 20), and group 2, patients treated with ACEI/ARB alone (n = 18). Their clinical and pathological characteristics were collected; we analyzed the therapeutic responses and assessed the correlation between renal and liver pathologies.
Our results showed that the most common type of HBV-GN was IgA nephropathy. LAM plus ACEI/ARB therapy was better in reducing 24-h urinary protein excretion, alanine aminotransferase, and aspartate aminotransferase levels, while maintaining the level of kidney function. The proportion of patients who achieved remission (CR + PR) was higher in the LAM plus ACEI/ARB group than in the ACEI/ARB monotherapy group (χ 2 = 5.371, P = 0.035).
In the HBV-GN patients with mild to moderate proteinuria, LAM plus ACEI/ARB not only improved liver function but also better reduced 24-h proteinuria.