Chronic hepatitis B and risk of kidney involvement

The aim of review. To present data on causes, pathogenesis, clinical manifestations and prognosis of renal disease at chronic hepatitis B (CHB).

Key points. Renal disease at chronic hepatitis B can be assessed from several points of view. First of all, it is HBV-associated glomerulonephritis developed as systemic manifestation of infection and presented, as a rule, by membranous nephropathy in children and mesangiocapillary glomerulonephritis in adults, resulting in chronic renal failure (CRF) in 30% of cases, while program hemodialysis is required in 10% of patients. Moreover, renal disease may be caused by medications used for CHB treatment, e.g. direct nephrotoxicity of adefovir or tenofovir, alpha interferon-induced glomerulonephritis, etc. Relation of HBV-infection to periarteritis nodosa - necrotizing vasculitis, ischemic nephropathy is known. Issue of CHB is important in patients who are undergoing substitution treatment: hemodialysis or post kidney transplantation. Antiviral therapy is indicated to the most of these patients which potential, at the same time, is limited by initially decreased renal function, nephrotoxicity of some drugs or simultaneous prescription of immunosuppressants after organ transplantation. At development of liver cirrhosis (LC) and its decompensation one more aspect of renal disease at CHB arises i.e. risk of hepatorenal syndrome (HRS) of the 1st or 2nd type that is a poor prognostic marker and requires individual therapeutic approach.

Conclusion. HBV-associated renal disease can develop as glomerulonephritis within systemic CHB manifestation or as complication of interferon-therapy due to nephrotoxicity of some antiviral agents, or as infection during replacement renal therapy (hemodialysis, transplantation of kidneys, etc.), as well as acute damage of kidneys or CRF (HRS of the 1st or 2nd type) in patients with decompensated LC at CHB outcome. Telbivudine is a drug of choice among new anti-HBV agents for treatment of patients, having high risk of renal disease, which demonstrates not only absence of nephrotoxicity, but also the proved predictable improvement of renal function.

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