Renal Impairment in Chronic Hepatitis B: A Review

Abstract

The liver plays a key role in the metabolism of proteins. Liver dysfunction affects many organs because it communicates with the spleen and all digestive organs through the portal vein. Additionally, the kidney is an organ that is closely related to the liver and is involved in liver diseases. Glomerulonephritis is an important extrahepatic manifestation of chronic hepatitis B virus (HBV) infection. Nucleos(t)ide analog (NA) therapy effectively suppresses HBV replication by inhibiting HBV polymerase, thus decreasing the levels of serum HBV-DNA and delaying the progression of cirrhosis. Although NA therapy is recommended for all patients with chronic HBV infection, regardless of the level of renal dysfunction, there is limited information on NA use in patients with chronic kidney disease. In addition, in patients with end-stage liver cirrhosis, hepatorenal syndrome can be fatal. Hence, we should take into account the stage of impaired renal function in patients with cirrhosis. The aims of this article are to review the epidemiology, clinical presentation, treatment, and prevention of HBV-associated nephropathy.

Keywords: HBV-associated glomerulonephritis; hepatitis B; hepatorenal syndrome.

Figure 1

Electron microscope: Kidney histology of a patient with hepatitis B virus (HBV)-related membranous nephropathy (MN). There was irregularity of the basement membrane and a large number of granular accretions (open circle) were recognized on the basement membrane subcutaneously. (Image courtesy of Dr. Tadashi Yamamoto , Center of Biofluid Biomarker, Niigata University, Niigata, Japan).