Impact of Abnormal Liver Enzymes on Long-term Renal Outcome in Patients with Hepatitis B Virus Infection and IgA Nephropathy

Tsai-Jung Wang ； Mei-Chin Wen ； Chi-Hung Cheng ； Ming-Ju Wu ； Cheng-Hsu Chen ； Tung-Min Yu ； Ya-Wen Chuang ； Shih-Ting Huang ； Shang-Feng Tsai ； Kuo-Hsiung Shu

《Acta Nephrologica》 26卷4期 (2012/12) Pp. 218-226

https://doi.org/10.6221/AN.2012016

並列摘要

BACKGROUND: IgA nephropathy (IgAN) is the most common form of glomerulonephritis among patients undergoing renal biopsy. Several conditions are associated with IgAN. Hepatitis B virus (HBV) infection has been reported to be a common secondary cause of IgAN. The aim of this study was to delineate whether abnormal liver enzymes or the presence of cirrhosis is associated with unfavorable renal outcome in patients with HBV infection and IgAN (HBV+IgAN). METHODS: We retrospectively reviewed our renal biopsy database covering the past 28 years. Sixty-seven cases with both HBs antigenemia and biopsy-proven IgAN were identified and all relevant medical records were reviewed. We excluded patients with incomplete medical records, those whose serum aminotransferase levels were not obtained, hepatitis C virus (HCV) carriers and patients with less than 3 months of post-biopsy follow-up. A total of 45 patients were recruited for this study. RESULTS: Patients had been followed up for an average of 138.9 ± 130.9 months after the confirmation of diagnosis. The mean age at the time of renal biopsy was 35.1 ± 11.0 years. They were divided into two groups according to the final renal outcomes. The ”progressive” group included patients with deterioration to end-stage renal disease (ESRD) or doubled values of serum creatinine (Cr). All the other patients were included in the ”stable” group. Compared with the stable group, the progressive group had a significantly higher baseline serum Cr, a lower baseline estimated glomerular filtration rate (eGFR), higher urine protein, lower hematocrit, higher incidence of hypertension (HTN), higher grade of Haas's sub-classification, and higher incidence of liver abnormality detected during follow-up (defined as ＞ 2-fold the upper normal limits of liver transaminase levels or the presence of cirrhosis). Multivariate Cox regression analysis demonstrated that higher maximal liver transaminase during follow-up periods or presence of cirrhosis was independently associated with unfavorable renal outcome (Hazard ratio [HR] in Model B: 4.24, 95% CI: 1.17-15.34, P=0.03). Median renal survival was 7.9 years in 13 patients with liver dysfunction compared with 28.2 years in patients without liver dysfunction (P=0.0009). Kaplan-Meier analysis revealed that the 1-year (HR: 0.22, 95% CI: 0.07-0.68, P=0.0086), 5-year (HR: 0.18, 95% CI: 0.06-0.55, P=0.0023) and 10-year (HR: 0.18, 95% CI: 0.54, P=0.0022) renal survival rates were significantly decreased in patients with liver abnormality. CONCLUSION: Abnormal liver enzymes or the presence of cirrhosis was associated with an increased rate of progression to ESRD in our patients with chronic HBV infection and IgAN. Close monitoring of liver function and prompt treatment are mandatory in such patient groups.

並列關鍵字

hepatitis B virus ； IgA nephropathy ； renal biopsy ； viral hepatitis