Complete remission of minimal change disease after antiviral monotherapy in a patient with immune-active chronic hepatitis B: A case report.
Tae Won Lee, Ha Nee Jang, Dae Hyun Song et al.
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Case in brief
A 42-year-old woman presented with generalized edema, weight gain, hypoalbuminemia, and nephrotic-range proteinuria, with a urine protein-to-creatinine ratio of 4.3 and preserved renal function. Testing showed immune-active chronic hepatitis B, including a high viral load. Kidney biopsy demonstrated nearly normal glomeruli by light microscopy, diffuse podocyte foot process effacement by electron microscopy, and no significant immune complex deposition, confirming minimal change disease. During tenofovir alafenamide monotherapy, proteinuria improved to a ratio of 0.2 and complete remission was achieved at 8 months; remission and viral suppression persisted through 3 years of follow-up.
What made this case unusual
The case describes biopsy-confirmed minimal change disease in the setting of immune-active chronic hepatitis B, with sustained remission during antiviral monotherapy. The authors note that spontaneous remission and concurrent angiotensin receptor blocker therapy could also have contributed.
Diagnostic / clinical pearl
In a patient with nephrotic syndrome and active hepatitis B, renal biopsy can distinguish minimal change disease from other HBV-associated glomerular lesions and inform treatment planning.
Why it matters
The report highlights a potential concern with corticosteroid treatment in active hepatitis B: it may exacerbate viral replication and hepatic injury.