Department of Internal Medicine, Division of Nephrology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ren Fail. 2013;35(4):446-51. doi: 10.3109/0886022X.2013.775659. Epub 2013 Mar 18.
The aim of this study is to investigate the clinical characteristics and our experience of treating patients with IgA nephropathy (IgAN) and IgA nephropathy with hepatitis B surface antigen (HBs-IgAN).
From 1996 to 2011, biopsy-proven IgAN was diagnosed in 477 patients and 22 (4.6%) had hepatitis B surface antigen (HBsAg). Of these, we included 360 patients who had more than 6-month follow-up period, and compared clinical characteristics and renal function decline between the patients with IgAN and HBs-IgAN.
Of 360 patients, 22 were classified as HBs-IgAN. There were no differences in the clinical characteristics and renal function decline between idiopathic IgAN and HBs-IgAN (-0.01 vs. -0.17 mL/min per 1.73 m(2)/month, p = 0.319). Of 22 patients with HBs-IgAN, nine had hepatitis B virus (HBV) replication marker (RM), of which six were treated with anti-viral agents. However, there were no differences in renal function decline and urinary protein excretion between patients who did or did not receive anti-viral therapy. Five patients with HBs-IgAN received corticosteroid therapy. Of these, three without HBV RM and one with HBV RM who received entecavir did not exhibit active viral replication, whereas the other patients with HBV RM experienced viral replication after lamivudine was discontinued.
There were no differences in the clinical characteristics and prognosis between the patients with IgAN and HBs-IgAN. Further, there were no differences in renal function decline and urinary protein excretion between patients with and without anti-viral therapy. Anti-viral therapy may be considered for treating patients with HBs-IgAN receiving immunosuppressants according to HBV RM.
本研究旨在探讨 IgA 肾病（IgAN）和乙型肝炎表面抗原（HBs-IgAN）患者的临床特征和治疗经验。
1996 年至 2011 年间，经活检证实的 IgAN 患者共 477 例，其中 22 例（4.6%）乙型肝炎表面抗原（HBsAg）阳性。在这 22 例患者中，我们纳入了 360 例随访时间超过 6 个月的患者，比较了 IgAN 和 HBs-IgAN 患者的临床特征和肾功能下降情况。
360 例患者中，22 例为 HBs-IgAN。特发性 IgAN 和 HBs-IgAN 患者的临床特征和肾功能下降无差异（-0.01 与-0.17 mL/min/1.73 m2/月，p = 0.319）。22 例 HBs-IgAN 患者中，有 9 例有乙型肝炎病毒（HBV）复制标志物（RM），其中 6 例接受了抗病毒治疗。然而，接受或未接受抗病毒治疗的患者肾功能下降和尿蛋白排泄无差异。5 例 HBs-IgAN 患者接受了皮质类固醇治疗。其中，3 例无 HBV RM，1 例有 HBV RM 且接受了恩替卡韦治疗，未出现活跃的病毒复制，而另 2 例有 HBV RM 的患者在停用拉米夫定后出现病毒复制。
IgAN 和 HBs-IgAN 患者的临床特征和预后无差异。此外，接受或未接受抗病毒治疗的患者肾功能下降和尿蛋白排泄无差异。对于接受免疫抑制剂治疗的 HBs-IgAN 患者，可根据 HBV RM 考虑抗病毒治疗。
