ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2018;7(2):93-97.
doi:10.15171/jnp.2018.22

Case Report

Anti-phospholipase A2 receptor antibody positive hepatitis B virus-associated membranous nephropathy remitted with entecavir after relapse with lamivudine

Yosuke Sasaki 1 * , Yohko Nagai 1, Tetsuo Mikami 2, Yoshikiyo Akasaka 3, Kazutoshi Shibuya 4, Yoshihisa Urita 1

1 Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-Ku, Tokyo, Japan
2 Department of Pathology, Toho University School of Medicine, Ota-Ku, Tokyo, Japan
3 Advanced Medical Research Center, Toho University School of Medicine, Ota-Ku, Tokyo, Japan
4 Department of Surgical Pathology, Toho University School of Medicine, Ota-Ku, Tokyo, Japan
*Corresponding author: Yosuke Sasaki, Email: yousuke.sasaki@med.toho-u.ac.jp

Abstract

Background: Phospholipase A2 receptor (PLA2R) is thought to be an intrinsic antigen of idiopathic membranous nephropathy (IMN), and has been widely used for the differentiation from secondary membranous nephropathies. However, the positive expression of PLA2R in the patients with hepatitis B virus associated membranous nephropathy (HBV-MN) is controversial in Asian countries, because co-localization of PLA2R and HBV antigens in glomeruli have been reported.

Case Presentation: We report a case of anti PLA2R antibody positive HBV-MN that was remitted with entecavir after a relapse during treatment with lamivudine. In a renal biopsy of the case, we could confirm the co-localized glomerular deposition of HBV surface antigen (HBs-Ag) and PLA2R using double staining of immunofluorescence. We also could observe the relapse of nephrotic syndrome correlated with the increased titer of HBs-Ag, and the remission with the decrease of HBs-Ag by the change of antiviral agents.

Conclusions: Our case demonstrated that the renal manifestation of HBV-MN clearly responded to antiviral agents. Furthermore, the co-localized glomerular depositions of PLA2R and HBs-Ag in HBV-MN may be concerned with the etiology of MN patients with chronic HBV infection.

Implication for health policy/practice/research/medical education:

Our case demonstrated clear response of the renal manifestation of HBV infection to antiviral agents, and co-localized glomerular depositions of PLA2R and HBs-Ag that may be concerned with the etiology of HBV-associated membranous nephropathy such as possibilities of cross-antigenicity between PLA2R and HBs-Ag, or structural changes in PLA2R due to HBV infection.

Please cite this paper as: Sasaki Y, Nagai Y, Mikami T, Akasaka Y, Shibuya K, Urita Y. Anti-phospholipase A2 receptor antibody positive hepatitis B virus-associated membranous nephropathy remitted with entecavir after relapse with lamivudine. J Nephropathol. 2018;7(2):93-97. DOI: 10.15171/jnp.2018.22.

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Submitted: 04 Aug 2017

Accepted: 10 Nov 2017
First published online: 20 Nov 2017
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