The Short-Time Efficacy And Safety Of Medium Dose Corticosteroids In The Treatment Of Seronegative HBV-MN

OBJECTIVE: Hepatitis B virus-associated glomerulonephritis(HBV-MN)remains one of the most common secondary glomerular diseases in Asia.The preliminary diagnosis criteria and treatment about patients with serological positive HBV-MN has formed,suggested on the basis of antiviral treatment combined corticosteroid,or immunosuppressants,or traditional Chinese medicine.But few studies can be found about the treatment of HBV-MN with serological negative,whether it can use the same therapies as HBV-MN with serological positive or idiopathic membranous nephropathy remains an open question,especially in patients with nephrotic syndrome.Our study explored the efficacy and safety of medium dose corticosteroids in the treatment of seronegative hepatitis B virus associated membranous nephropathy with nephrotic syndrome,it will provide clinical basis for the application of corticosteroids treatment in serological negative HBV-MN in the future.METHODS: A prospective study was carried out in 29 patients with biopsy-proven HBV-MN under ultrasound guidance in our hospital due to nephrotic syndrome from September 2008 to January 2016,whose HBV antigen was discovered in the renal pathological section but HBsAg,HBeAg,and HBV-DNA was all negative in the serum.The 29 cases of patients were given the medium dose corticosteroids treatment(methyl prednisolone,0.8 mg/kg/d)for 12 weeks initially,then gradually reduced.We observed the levels of 24 hours urinary protein,serum albumin,liver and kidney functions,HBV serological indexes and adverse reactions such as raised blood glucose,liver function damage,deterioration of renal function,infection in 1 month,3 months,6 months after treatment,we followed up for 6 months.RESULT: 29 cases of patients were given medium dose corticosteroids,there were no serious adverse reactions during the follow-up,there were no significant changes in serum Creatinine,3 patients had abnormal ALT fluctuation,the rest of patients had no obvious change.After a month treatment of corticosteroids,the proteinuria was significantly decreased(5.73±2.43g/d vs 3.80±1.74g/d,P<0.05),and the serum albumin levels was significantly improved(23.34 ± 4.75g/L vs 28.79 ±7.44g/L,P<0.05).4 patients achieved partial remission,and the overall remission rate was 14%.At 3-months therapy of corticosteroids,the proteinuria was significantly decreased(5.73±2.43g/d vs 2.62±1.82g/d,P<0.05),and the serum albumin levels was significantly improved(23.34±4.75g/L vs 34.03±6.05g/L,P<0.05).Complete remission rate was achieved in 14% of the patients,the partial remission rate achieved in 41% of the patients,the overall remission rate was 55%.At the 6-months therapy,the proteinuria was significantly decreased(5.73 ± 2.43g/d vs 1.81 ± 1.85g/d,P<0.05),and the serum albumin levels was significantly improved(23.34±4.75g/L vs 35.64 ± 7.46g/L,P<0.05).8 patients achieved complete remission(28%)and 12 patients achieved partial remission(41%),and the overall remission rate was 69%.CONCLUSION:1.In our study,there were more female casaes than male cases in serological negative HBV-MN,different from the strong male predominance in previous studies on HBV-GN characteristics,indicating that the differences between the sexes were gradually reduced.2.Serological negative HBV-MN can be seen in all age groups,young adults were more common.There is no significant difference in the remission rate between different sexes and different ages when using corticosteroids therapy in this study.3.Single steroid can be used in seronegative HBV-MN patients with nephrotic syndrome,there is no need to combine antiviral treatment initially.4.The related serum HBV maekers and serum HBV-DNA should be monitored closely during corticosteroid therapy.Once HBsAg,HBeAg appeared positive or HBV-DNA replicationin happened,antiviral treatment should be applied.5.The corticosteroids therapy on seronegative HBV-MN showed a definite effect,the remission rate would grow with the prolonged treatment,the adverse reactions were controllable during treatment.6.The efficacy of steroid therapy on snHBV-MN is accurate,antiviral therapy is unclear,our study proves that immune factors participate in the pathogenesis of snHBV-MN,which may be the main pathogenic mechanism.