Lamivudine in hepatitis B-associated membranous nephropathy

Background: Although lamivudine is effective for the treatment of chronic hepatitis B (HBV) infection, its potential therapeutic impact on HBV-related membranous nephropathy (MN) in adults has not been characterised. Methods: We treated 10 HBsAg-positive patients with biopsy-proven MN, elevated serum alanine aminotransferase (ALT), and HBVDNAemia (group 1), and compared their clinical course with 12 patients diagnosed to have HBV infection, elevated serum ALT, and MN in the pre-lamivudine era (group 2). Results: Baseline demographic and clinical parameters were not significantly different between the 2 groups. In group 1, lamivudine treatment was associated with significant reduction in proteinuria, increase in serum albumin, normalisation of ALT levels and disappearance of circulating HBV-DNA during the first year. Four (40%) and six (60%) patients went into complete remission (proteinuria < 0.3 g/day) at 6 and 12 months, respectively. In group 2, significant proteinuria persisted during the first year. One (8.3%) and three (25%) patients went into remission. Cumulative 3-year renal survival (using endstage renal disease as the primary end point) was 100% in group 1 and 58% in group 2 (p = 0.024, log rank test). Blood pressure control reached the target of < 130/85 mmHg in both groups. Lamivudine was well tolerated and not associated with any adverse events. Hepatic decompensation or malignancy was not observed during follow up in both groups. Conclusion: HBV-related MN led to end-stage renal disease in a significant proportion of patients before the advent of anti-viral therapy. Lamivudine treatment improves renal outcome in HBV carriers with MN and evidence of liver disease