Hepatitis B virus-associated nephropathy in a patient with diabetes mellitus

Abstract

Hepatitis B virus (HBV)-associated nephropathy is not a rare manifestation of HBV infection; this could result in diagnostic confusion and the possible misidentification of a diabetic patient with albuminuria. We present the first published case of a HBV-associated nephropathy occurring in a patient with diabetes. The patient was a 24-year-old man who was admitted to hospital with 4 days of generalized swelling and oliguria. He had a 3-year history of weight loss, and a 1-year history of polydipsia and polyuria before the symptoms of generalized swelling and oliguria appeared. Laboratory tests showed a fasting blood sugar of 15.1 mmol/L and glycated hemoglobin of 18.1%. The 24-h urine protein excretion was 2807.8 mg and serum albumin was 19.1 g/L. The diagnosis of HBV-associated nephropathy was confirmed by serological evaluations of HBV antigen and antibodies, immunohistochemical evidence of HBV-related antigens, and immune complexes in renal biopsies. The decreased proteinuria was observed after antiviral therapy.

Keywords: Diabetes mellitus; Diabetic nephropathy; Hepatitis B virus‐associated nephropathy.

Figure 1

Renal pathology findings. (a) The glomerulus shows a mild increase in mesangial matrix and mesangial cells, and thickening of the peripheral capillary walls. (b) Electron microscopy shows large electron dense subepithelial deposits in the glomerular basement membrane. (c) Peroxidase antiperoxidase staining for hepatitis B virus surface antigen is positive. (d) Immunofluorescent microscopy shows granular immunoglobulin G staining along the periphery of the glomerular basement membrane.