Nakaji M, Igaki N, Moriguchi R, Akiyama H, Tamada F, Goto T
Department of Internal Medicine, Takasago Municipal Hospital, Hyogo, Japan.
Nihon Jinzo Gakkai Shi. 2000 Jul;42(5):388-93.
We report a patient, a 23-year-old man, who was a hepatitis B virus(HBV) carrier complicated with nephrotic syndrome. He was admitted to our hospital because of generalized edema and massive ascites. Laboratory data on admission were as follows: proteinuria 9,850 mg/day, Cr 2.7 mg/dl, BUN 73 mg/dl, albumin 1.9 g/dl, cholesterol 501 mg/dl, GOT 23 IU/l, GPT 19 IU/l, HBsAg(+), and HBeAg(222.7). Since his nephrotic symptoms were seriously complicated with renal failure, we selected steroid therapy for nephrosis preference. His renal function was improved and the urinary protein decreased immediately, but his liver function deteriorated. The renal biopsy revealed focal mesangial proliferative glomerulonephritis. Immunofluorescent examination revealed slight deposits of IgG, IgM, and C3 along the glomerular basement membrane and mesangial matrix. He was not compliant and often stopped taking the steroid therapy, thereby causing nephrosis to recur each time. After all, nephrotic symptoms have been well-controlled with cyclosporin and steroid. In spite of the seroconversion of HB virus by formation of HBe antibody, mutant HBV infection continued. The fact that liver biopsy revealed severe lymphoid infiltration at the portal area suggested chronic active hepatitis. His clinicopathologic course suggests that HBV-associated nephropathy does not always remit as there are some cases in whom hepatitis remains in an active state even after seroconversion, due to its mutant status. In these cases, the long-term prognosis of HBV nephropathy has not been defined. Further study is necessary to establish the optimal treatment for HB nephropathy in adults.
我们报告了一名23岁男性患者，他是一名乙型肝炎病毒（HBV）携带者，并发肾病综合征。他因全身水肿和大量腹水入院。入院时的实验室检查数据如下：蛋白尿9850mg/天，肌酐2.7mg/dl，尿素氮73mg/dl，白蛋白1.9g/dl，胆固醇501mg/dl，谷草转氨酶23IU/l，谷丙转氨酶19IU/l，乙肝表面抗原（+），乙肝e抗原（222.7）。由于他的肾病症状严重并发肾衰竭，我们选择优先使用类固醇疗法治疗肾病。他的肾功能得到改善，尿蛋白立即减少，但肝功能恶化。肾活检显示局灶性系膜增生性肾小球肾炎。免疫荧光检查显示IgG、IgM和C3沿肾小球基底膜和系膜基质有轻微沉积。他不依从治疗，经常停止服用类固醇疗法，从而每次都导致肾病复发。毕竟，肾病症状已通过环孢素和类固醇得到良好控制。尽管通过形成乙肝e抗体实现了乙肝病毒的血清学转换，但变异型HBV感染仍在继续。肝活检显示门静脉区有严重淋巴细胞浸润这一事实提示为慢性活动性肝炎。他的临床病理过程表明，HBV相关性肾病并不总是缓解，因为有些病例即使在血清学转换后肝炎仍处于活动状态，这是由于其变异状态所致。在这些病例中，HBV肾病的长期预后尚未明确。有必要进一步研究以确定成人HB肾病的最佳治疗方法。
