Kanaan N, Horsmans Y, Goffin E
Department of Nephrology, Université catholique de Louvain, Cliniques Universitaires St. Luc, Brussels, Belgium.
Clin Nephrol. 2006 Mar;65(3):208-10. doi: 10.5414/cnp65208.
A 57-year-old man presented with nephrotic syndrome associated with active HBV infection. Liver biopsy showed severe portal and moderate lobular inflammation, patchy necrosis, moderate fibrosis and several "ground glass" cells. Immunofluorescence microscopical view of the renal biopsy showed diffuse granular IgG deposits along the glomerular basement membrane, compatible with MN. As symptomatic therapy with ACE inhibitors did not improve the nephrotic syndrome, lamivudine 100 mg o.d. was initiated. HBV-DNA became undetectable after 10 weeks and seroconversion of HBeAg and HBsAg to anti-HBe and anti-HBs occurred after 2 additional months; proteinuria normalized subsequently. This observation documents for the first time in an adult the beneficial effect of lamivudine in glomerulonephritis related to HBV infection with HBV seroconversion and complete remission of the nephrotic syndrome.
一名57岁男性患者出现与活动性乙肝病毒（HBV）感染相关的肾病综合征。肝脏活检显示重度门脉炎症和中度小叶炎症、片状坏死、中度纤维化以及多个“毛玻璃样”细胞。肾活检的免疫荧光显微镜检查显示沿肾小球基底膜有弥漫性颗粒状IgG沉积，符合膜性肾病（MN）。由于使用血管紧张素转换酶（ACE）抑制剂的对症治疗未能改善肾病综合征，遂开始每日口服100mg拉米夫定。10周后HBV-DNA检测不到，再过2个月HBeAg和HBsAg血清学转换为抗-HBe和抗-HBs；随后蛋白尿恢复正常。该观察首次证明在成人中拉米夫定对与HBV感染相关的肾小球肾炎具有有益作用，可实现HBV血清学转换并使肾病综合征完全缓解。
