Minimal Change Nephrotic Syndrome in Patients with HBs Antigenemia

Lee, Sang Goo; Ahn, Cu Rie; Oh, Yun Kyu; Kim, Yon Su; Yoon, Hyung Jin; Lee, Hyun Sun; Han, Jin Suk; Kim, Suhng Gwon; Lee, Jung Sang

Abstract

Minimal change nephrotic syndrome is the most common cause of adult nephrotic syndrome in Korea as well as in Asia. Even though hepatitis B virus (HBV) infection has been infrequently noted in patients with minimal change nephrotic syndrome, and even though there is a controversy in using steroid in patients with hepatitis B virus infections, impacts of HBV infection on the clinical course and the therapeutic modalities has not been evaluated. To elucidate this, we analysed clinicopathologic manifestations of 21 minimal change nephrotic syndrome patients with HBs antigenemia(HB-MCNS), in comparision with 25 minimal change nephrotic syndrome patients without any evidence of HBV infection(MCNS). The prevalence rate of HBs antigenimia among minimal change nephrotic syndrome was 8.7%. Age at diagnosis(median; HB-MCNS, 28 vs. MCNS, 22years : P<0.05), serum albumin level(median; HB- MCNS, 2.1 vs. MCNS, 1.8g/dL : P<0.05) and serum IgG level(median; HB-MCNS, 541 vs. MCNS, 271mg/dL : P<0.05) of HB-MCNS were higher than MCNS. C4(median; HB-MCNS, 36 vs. MCNS, 55mg/ dL : P<0.05) was lower. Other clinical findings including sex ratio, amount of 24HU protein, degree of hypercholesterolemia, seropositive rates for serologic markers such as rheumatoid factor, cryoglobulin, and ANA were not different between HB-MCNS and MCNS. The cumulative remission rates of 17 HB-MCNS patients who received steroid or cytotoxic therapy were 85% at 8th weeks and 100% at 11th weeks. Nephrotic syndrome was relapsed in 8% at 8th weeks and 38% at 70th weeks. These remission and relapse rate were not different from that of MCNS. During the course of steroid treatments, serum aspartate/alanine aminotransferase levels were elevated in 6 patients. Among those, 2 patients showed abnormal liver function persistent more than 4 weeks. One of them had positive seroconversion of HBeAg, and the other was proved to have liver cirrohsis. The negative seroconversion of HBeAg was not associated with clinical remission. Clinical finding suggested that HBV infection is unlikely a cause for most HB-MCNS. Even though steroids and cytotoxic agents was effective in HB-MCNS as much as in MCNS, careful monitoring of liver function and HBV marker is needed.