Entecavir therapy in patients with hepatitis B virus-associated glomerulonephritis

Objective To investigate the efficacy and safety of entecavir (ETV) in treatment of patients with hepatitis B virus-associated glomerulonephritis (HBV-GN) with different creatinine clearance rates (Ccr). Methods A total of 108 patients with HBV-GN in the Fifth People's Hospital of Wuxi during July 2006 and January 2012 were enrolled. According to Ccr levels, all patients were divided into group A (≥80 mL/min, n=32), group B (50-<80 mL/min, n=31), group C (30-<50 mL/min, n=25) and group D (<30 mL/min, n=20). All patients received conventional therapy and ETV treatment for 52 weeks, and the dosages of ETV were 0.5, 0.5, 0.25 and 0.15 mg/d for group A, B, C and D, respectively. Chi-square or exact probability tests were used to compare biochemical, virological and serological responses, as well as improvements on kidney function, Ccr and 24 h urinary protein excretion among 4 groups after 52 weeks treatment. Results After 52 weeks of treatment, ALT levels and HBV DNA loads in all groups were significantly decreased (P 0.05). Rates of blood urea nitrogen (BUN) improvements in group B, C and D were 32.3%, 8.0% and 5.0%; rates of serum creatinine (Scr) improvement in 3 groups were 25.8%, 4.0% and 0; rates of Ccr improvements in 3 groups were 25.8%, 4.0% and 0. There were more significant improvements in group B than those in group C and D (P<0.05). Rates of 24 h urinary protein excretion decreasing in 4 groups were 53.1%, 41.9%, 8.0% and 0, and rates in group A and B were significantly higher than those in group C and D (P<0.05). No severe ETV-associated adverse reaction was observed in 4 groups. Conclusions ETV therapy can improve liver functions of patients with HBV-GN, and can achieve good virological and serological responses. For those with Ccr≥50 mL/min, renal function can also be improved and 24 h urinary protein excretion can be reduced. Key words: Glomerulonephritis; Hepatitis B virus; Entecavir; Renal insufficiency; Creatinine clearance rate