C ( Hepatitis C virus ) ( Membranoproliferative glomerulonephritis ) ( Membranous nephropathy ) ( Focal segmental glomerulosclerosis )
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1 ( extrahepatic manifestations ) ( membranoproliferative glomerulonephritis ) ( membranous nephropathy ) ( focal segmental glomerulosclerosis ) ( immunosuppressive therapy ) ( plasma-exchange ) ( Hepatitis virus ) ( Membranoproliferative glomerulonephritis ) ( Membranous nephropathy ) ( Focal segmental glomerulosclerosis ) ( membranoproliferative glomerulonephritis ) 3 ( membranous glomerulonephritis ) 36%-40% 80%~100% B ( extrahepatic manifesta- 30%~45% 1 tions ) porphyria cutanea tarda ( SLE ) ( sicca syndrome ) 90% B 2 4% 4-6 B % 7 B 1993 Johnson RJ ;
2 Johnson RJ % ( cryoglobulinemia ) 4 ( idiopathic ) RNA 9.5kb E1 E2 P7 NS2 NS3 NS4AB NS5AB RNA RNA ( negative strand RNA ) RNA 13,14 ( complement ) rheumatoid factor ( immune complex ) ( purpura ) ( arthralgia ) ( neuropathy ) ( weakness ) ( nephrotic syndrome ) 8 ( mesangial ) ( toll-like receptor 3, TLR3 ) 15 porphyria cutanea tarda ( membranous nephropathy ) 2.7% rheumatoid factor 10 ( focal segmental glomerulosclerosis, FSGS ) HIV Sabry A 24% 6, 8 Stehman-Breen ( hypocomplementemia ) cryoglobulinemia rheumatoid factor GFR 16 Okada K ( indirect immunofluorescence ) ( HV core protein ) 17 7,18 hepatitis virus RNA hepatitis virus RNA 19 IgA nephropathy fibrillary glomerulonephritis immunotactoid glomerulopathy 8 ( Symptomatic therapy )
3 ( angiotensin converting enzyme inhibitors, AEI ) ( HV anti-viral therapy ) 1994 Misiani R ( Interferon alfa-2a ) 21 Johnson RJ ( Intron-A ) g/day g/day HV RNA 22 H u SL 23 0 mg 400 mg 600 mg Protein/reatinine ( immunosuppressive therapy) ( plasma-exchange ) yclophosphamide B-lymphocyte cryoglobulins ( steroid pulse therapy ) cryoglobulinemia cryoglobulin yclophosphamide ( remission ) 27 ALT 5X ( bilirubin 2g/dL ) ( pegylated -interferon ) ( conventional -INF ) 3 MU 3 ( pegylated -INF ) 1.5 g/kg/week mg/d ( mmol ) 24 67% ( erythropoietin ) flu-like syndrome 10 g/dl 750/mm 3 80,000/mm 3 8 g/dl 500/mm 3 25,000/mm B 15 B 9.8% % B D- (Anti-D monoclonal antibody therapy Rituximab) B-lymphocyte, 30 NS3-4A protease inhibitors ( BILN 61 ) NS5B polymerase inhibitors 31, 32
4 262 1.Brady HR, O'Meara YM, Brenner BM. Glomerular disease. In: Kasper DL, Braunwald E, Fauci AS, et al, eds Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw- Hill; 05; Hsu H, Lin GH, hang MH, hen H. Association of hepatitis B surface (HBs) antigenemia and membranous nephropathy in children in Taiwan. lin Nephrol 1983; : Johnson RJ, Gretch DR, Yamabe H, et al. Membranoproliferative glomerulonephritis associated with hepatitis virus infection. N Engl J Med 1993; 328: acoub P, Renou, Rosenthal E, et al. Extrahepatic manifestations associated with hepatitis virus infection. A prospective multicenter study of 321 patients. Medicine 00; 79: Ali A, Zein NN. Hepatitis infection: a systemic disease with extrahepatic manifestations. leve lin J Med 05; 72: Sterling RK, Bralow S. Extrahepatic manifestations of hepatitis virus. urr Gastroenterol Rep 06; 8: Sabry A, E-Agroudy A, Sheashaa H, et al. HV associated glomerulopathy in Egyptian patients: clinicopathological analysis. Virology 05; 334: Meyers M, Seeff LB, Stehman-Breen O, et al. Hepatitis and renal disease: an update. Am J Kidney Dis 03; 42: Arase Y, Ikeda K, Murashima N, et al. Glomerulonephritis in autopsy cases with hepatitis virus infection. Intern Med 1998; 37: Stehman-Breen, Alpers E, ouser WG, et al. Hepatitis virus associated membranous glomerulonephritis. lin Nephrol 1995; 44: di Belgiojoso GB, Ferrario F, Landriani N. Virus-related glomerular diseases: histological and clinical aspects. J Nephrol 02; 15: Stehman-Breen, Alpers E, Fleet WP, et al. Focal segmental glomerular sclerosis among patients infected with hepatitis virus. Nephron 1999; 81: ABDE 06; 33: B 06; 33: Wornle M, Schmid H, Banas B, et al. Novel role of toll-like receptor 3 in hepatitis -associated glomerulonephritis. Am J Pathol 06; 168: Tsui JI, Vittinghoff E, Shlipak MG, O'Hare AM. Relationship between hepatitis and chronic kidney disease: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol 06; 17: Okada K, Takishita Y, Shimomura H, et al. Detection of hepatitis virus core protein in the glomeruli of patients with membranous glomerulonephritis. lin Nephrol 1996; 45: Sabry AA, Sobh MA, Irving WL, et al. A comprehensive study of the association between hepatitis virus and glomerulopathy. Nephrol Dial Transplant 02; 17: Yamabe H, Nakamura N, Nakamura M, et al. Hepatitis virusassociated glomerulonephritis without hepatitis virus in the blood. Am J Kidney Dis 05; 46: e65-9..kamar N, Rostaing L, Alric L. Treatment of hepatitis -virusrelated glomerulonephritis. Kidney Int 06; 69: Misiani R, Bellavita P, Fenili D, et al. Interferon alfa-2a therapy in cryoglobulinemia associated with hepatitis virus. N Engl J Med 1994; 330: Johnson RJ, Gretch DR, ouser WG, et al. Hepatitis virus-associated glomerulonephritis. Effect of alpha-interferon therapy. Kidney Int 1994; 46: Hu SL, Jaber BL. monotherapy for hepatitis virusassociated membranous nephropathy. lin Nephrol 05; 63: Sherman M, ohen L, ooper MA, et al. linical recommendations for the use of recombinant human erythropoietin in patients with hepatitis virus being treated with ribavirin. an J Gastroenterol. 06; : Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis. Hepatology 04; 39: Sulkowski M. Management of the hematologic complications of hepatitis therapy. lin Liver Dis 05; 9: Kurihara I, Saito T, Nakayama K, et al. A case of hepatitis virus associated membranous glomerulonephritis ameliorated by corticosteroid therapy. Nippon Jinzo Gakkai Shi 1998; 40: Ni YH, hang MH, Huang LM, et al. Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination. Ann Intern Med 01; 135: Houghton M, Abrignani S. Prospects for a vaccine against the hepatitis virus. Nature 05; 436: Roccatello D, Baldovino S, Rossi D, et al. Long-term effects of anti-d monoclonal antibody treatment of cryoglobulinaemic glomerulonephritis. Nephrol Dial Transplant 04; 19: De Francesco R, Migliaccio G. hallenges and successes in developing new therapies for hepatitis. Nature 05; 43: Pawlotsky J. Therapy of hepatitis : from empiricism to eradication. Hepatology 06; 43: S7-.
5 263 Hepatitis Virus--Related Nephropathy hen-wang hang, heng-hsin hu, Wen-Hsiung hang, and Yi-hou hen 1 Division of Gastroenterology, 1 Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan The hepatitis virus general encroaches upon the liver and causing the liver pathological change. Liver cirrhosis and even hepatocelluar carcinoma can be seen in patient with HV infection. Except of liver, HV can involve other organ and causing many extrahepatic manifestations, nephropathy is one of the most important extrahepatic manifestations that maybe neglected. Most of the HV-related nephropathy is membranoproliferative glomerulonephritis, and membranous nephropathy, focal segmental glomerulosclerosis are also reported previously. Except of symptoms control, anti-hv therapy, immunosuppressive therapy and plasma-exchange can be used for treatment of HV related nephropathy. ( J Intern Med Taiwan 06; 17: )
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