SUCCESSFUL TREATMENT OF NEPHROTIC SYNDROME AND SEVERE RENAL FAILURE DUE TO HEPATITIS B VIRUS RELATED DIFFUSE PROLIFERATIVE GLOMERULONEPHRITIS, WITH IMMUNSUPPRESSIVE DRUGS
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Chronic hepatitis B virus (HBV) associated glomerular disease are mainly membranous glomerulonephritis, m embranoproliferative
glomerulonephritis, essential mixed cryoglobulinemia, IgA nephropathy and diffuse proliferative glomerulonephritis. The pathogenesis of HBV related GN has been defined as chronic antigenemia and passive deposition of immune complex in glomeruli. We reported here a patient with liver cirrosis and proliferative GN related with HBV.
A fortyl-one year old man, with history of hepatitis a 20 years ago was admitted to hospital due to generalized edema. Physical examination showed that ascites, pretibial edema and diminished pulmonary sounds. Laboratory investigations were as follows: BUN 86 mg/dl, creatinin 2.2 mg/dl, total protein 5 g/dl, serum albumin 2.3 g/dl, daily proteinuria 4g. and HbsAg positive. Liver and renal biopsy showed that chirrosis, and diffuse proliferative glomerulonephritis. In this patient, nephrotic syndrome and dialysis requiring acute renal failure regressed with corticosteroid and cyclophosphamide treatment. In follow-up period after 12 months, his renal function was within normal limits and proteinuria was negative.
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Kronik hepatit B virus(HBV) enfeksiyonu ile ilişkili glomerular hastalıklar arasında ınembranoz glome rulonefrit (GN), membranoproliferatif GN, esansiyel mixt kryoglobulinemi, IgA nefropatisi ve diffüzproliferatif GN sayılmaktadır.HBV ilişkili glomurulonefritlerin patogenezinde, kronik antijenemi ve glomerulde immün komplexlerin pasif birikimi suçlanmaktadır. Burada HBV ilişkili karaciğer sirozu ve diffüzproliferatif glomerulonefriti olan bir olgu sunulmuştur.
Yirmi yıl önce sarılık hikayesi olan 41 yaşında erkek hasta ödem nedeni ile kabul edildi. Fizik incelemede asit, pretibial ödem ve akciğer seslerinde azalma saptandı Laboratuar incelemede; BUN 86 mg/ di, kreatinin 2.2 mg/dl, total protein 5 g/dl, serum albumin 2.3 mg/dl, günlük proteinüri 4 g idi. HbsAg pozitif olarak bulundu.Karaciğer ve böbrek biyopsisinde, siroz ve diffüzproliferatif glomerulonefrit saptandı. Bu hastada, nefrotik sendrom ve diyaliz gerektiren akut böbrek yetersizliği kortikosteroid ve siklofosfamid tedavisi ile geriledi.Oniki aylık takibinde böbrek fonksiyonları normaldi ve proteinürisi negatifti.
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