Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
J Trop Pediatr. 2018 Jun 1;64(3):249-252. doi: 10.1093/tropej/fmx058.
We report the case of a 7-year-old unimmunized boy who presented with generalized anasarca for the first time, along with nephrotic-range proteinuria, hypoalbuminemia, microscopic hematuria and hypertension. Special investigations revealed ELISA test to be positive for hepatitis B surface antigen (HBsAg) and hepatitis B envelope antigen (HBeAg); hepatitis B viral DNA load (HBV DNA) level (real-time polymerase chain reaction) was 54 360 903 IU/ml. For hepatitis B virus (HBV)-related glomerulopathy, he was started on enalapril and lasilactone, and percutaneous renal biopsy was performed, which revealed membranous nephropathy (MN). A diagnosis of MN secondary to HBV infection contracted via horizontal transmission was made. The patient was started on peginterferon alfa-2b (50 μg/week) for 24 weeks. He failed to attain remission and seroconversion after interferon (IFN) therapy. Then, oral therapy with entecavir was started, and he attained remission as well as seroconversion after 3 months of therapy. He maintained his seroconversion status at his 6-month and the recent 12-month (quantitative HBV DNA level was 373 IU/ml) follow-up visit. Entecavir seems a promising drug for HBV-related glomerulopathy, especially in IFN-resistant cases.
我们报告了一例 7 岁未免疫男孩的病例，他首次出现全身性水肿，伴有肾病范围蛋白尿、低白蛋白血症、镜下血尿和高血压。特殊检查显示酶联免疫吸附试验（ELISA）乙肝表面抗原（HBsAg）和乙肝 e 抗原（HBeAg）阳性；乙型肝炎病毒 DNA 载量（HBV DNA）水平（实时聚合酶链反应）为 54360903IU/ml。对于乙型肝炎病毒（HBV）相关肾小球病，他开始接受依那普利和拉西酮治疗，并进行了经皮肾活检，结果显示为膜性肾病（MN）。诊断为乙型肝炎病毒感染引起的 MN，感染途径为水平传播。患者开始接受聚乙二醇干扰素 alfa-2b（50μg/周）治疗 24 周。干扰素（IFN）治疗后未能达到缓解和血清转换。然后开始口服恩替卡韦治疗，治疗 3 个月后达到缓解和血清转换。他在 6 个月和最近 12 个月（定量 HBV DNA 水平为 373IU/ml）的随访中保持了血清转换状态。恩替卡韦似乎是治疗 HBV 相关肾小球病的一种有前途的药物，特别是在 IFN 耐药的情况下。
