Complete remission of minimal change disease after antiviral monotherapy in a patient with immune-active chronic hepatitis B: A case report.
5 affiliations
- 1Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
- 2Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, South Korea.
- 3Institute of Health Science, Gyeongsang National University, Jinju, South Korea.
- 4Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
- 5Department of Pathology, Gyeongsang National University Changwon Hospital and Gyeongsang National University College of Medicine, Changwon, South Korea.
Abstract
Rationale
Minimal change disease (MCD) is characterized by diffuse podocyte foot process effacement on electron microscopy, minimal structural changes on light microscopy, and the absence of immune complex deposition on immunofluorescence. In adults, MCD accounts for approximately 10% to 25% of nephrotic syndrome cases and is typically idiopathic, although secondary causes such as infections, medications, malignancies, and immune disorders have been reported. The association between hepatitis B virus (HBV) infection and glomerular disease has been well established in membranous nephropathy and mesangial proliferative glomerulonephritis. However, HBV-associated MCD is rare.Patient concerns
A 42-year-old woman presented with a 1-week history of generalized edema and weight gain. Physical examination revealed severe bilateral pretibial pitting edema, and laboratory evaluation revealed hypoalbuminemia and nephrotic-range proteinuria.Diagnoses
The urine protein-to-creatinine ratio was elevated to 4.3, while renal function remained unchanged. Serological testing was positive for hepatitis B surface antigen and hepatitis B e-antigen, with a high viral load (HBV deoxyribonucleic acid 505,437 IU/mL), consistent with immune-active chronic hepatitis B infection. Renal biopsy showed nearly normal glomerular architecture on light microscopy, diffuse podocyte foot process effacement on electron microscopy, and no significant immune complex deposition on immunofluorescence, confirming MCD.Interventions
Antiviral therapy with tenofovir alafenamide 25 mg orally once daily was initiated and continued throughout the 3-year follow-up period.Outcomes
Proteinuria progressively improved, and complete remission was achieved at 8 months (urine protein-to-creatinine ratio, 0.2). The patient maintained sustained remission with persistent viral suppression during a 3-year follow-up.Lessons
Complete remission of MCD was temporally associated with antiviral monotherapy in a patient with immune-active HBV. Although potential confounding factors such as spontaneous remission or the supportive effects of concurrent angiotensin receptor blocker therapy cannot be entirely excluded, this case suggests that viral suppression may play a role in restoring podocyte function. Renal biopsy is essential for accurate diagnosis and treatment planning because corticosteroid therapy may exacerbate viral replication and hepatic injury. Antiviral monotherapy may represent a reasonable initial therapeutic strategy in select patients with biopsy-proven MCD and active hepatitis B infection.
Related
- High Frequency of Circulating IL-4R+SELL+ Naïve B Cells Is Associated with Functional Cure in Chronic Hepatitis B Patients Receiving Antiviral Treatment
- Safety, Tolerability and Antiviral Activity of GST‐HG131 in Chronic Hepatitis B: A Randomized, Double‐Blind Phase IIa Study
- Case Report: Hyperactive delirium with psychotic symptoms associated with severe hypothyroidism during pembrolizumab therapy. Complete remission after levothyroxine and no recurrence after pembrolizumab rechallenge
- Post-transplant BRAF/MEK inhibitor maintenance sustains complete remission in BRAF V600E-mutant histiocytic sarcoma.
- Complete remission with single agent lorlatinib in children with ALK+ anaplastic large cell lymphoma and central nervous system involvement: a case report
BibTeX
@article{lee2026complete,
title = {{Complete remission of minimal change disease after antiviral monotherapy in a patient with immune-active chronic hepatitis B: A case report.}},
author = {Tae Won Lee and Ha Nee Jang and Dae Hyun Song and Sehyun Jung and Seunghye Lee and Se-Ho Chang and Dong Jun Park and Dong Jun Park},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000050999},
url = {https://europepmc.org/article/MED/42888567},
note = {CC BY},
}
RIS
TY - JOUR
TI - Complete remission of minimal change disease after antiviral monotherapy in a patient with immune-active chronic hepatitis B: A case report.
AU - Tae Won Lee
AU - Ha Nee Jang
AU - Dae Hyun Song
AU - Sehyun Jung
AU - Seunghye Lee
AU - Se-Ho Chang
AU - Dong Jun Park
AU - Dong Jun Park
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000050999
UR - https://europepmc.org/article/MED/42888567
AB - Rationale Minimal change disease (MCD) is characterized by diffuse podocyte foot process effacement on electron microscopy, minimal structural changes on light microscopy, and the absence of immune complex deposition on immunofluorescence. In adults, MCD accounts for approximately 10% to 25% of nephrotic syndrome cases and is typically idiopathic, although secondary causes such as infections, medications, malignancies, and immune disorders have been reported. The association between hepatitis B virus (HBV) infection and glomerular disease has been well established in membranous nephropathy and mesangial proliferative glomerulonephritis. However, HBV-associated MCD is rare.Patient concerns A 42-year-old woman presented with a 1-week history of generalized edema and weight gain. Physical examination revealed severe bilateral pretibial pitting edema, and laboratory evaluation revealed hypoalbuminemia and nephrotic-range proteinuria.Diagnoses The urine protein-to-creatinine ratio was elevated to 4.3, while renal function remained unchanged. Serological testing was positive for hepatitis B surface antigen and hepatitis B e-antigen, with a high viral load (HBV deoxyribonucleic acid 505,437 IU/mL), consistent with immune-active chronic hepatitis B infection. Renal biopsy showed nearly normal glomerular architecture on light microscopy, diffuse podocyte foot process effacement on electron microscopy, and no significant immune complex deposition on immunofluorescence, confirming MCD.Interventions Antiviral therapy with tenofovir alafenamide 25 mg orally once daily was initiated and continued throughout the 3-year follow-up period.Outcomes Proteinuria progressively improved, and complete remission was achieved at 8 months (urine protein-to-creatinine ratio, 0.2). The patient maintained sustained remission with persistent viral suppression during a 3-year follow-up.Lessons Complete remission of MCD was temporally associated with antiviral monotherapy in a patient with immune-active HBV. Although potential confounding factors such as spontaneous remission or the supportive effects of concurrent angiotensin receptor blocker therapy cannot be entirely excluded, this case suggests that viral suppression may play a role in restoring podocyte function. Renal biopsy is essential for accurate diagnosis and treatment planning because corticosteroid therapy may exacerbate viral replication and hepatic injury. Antiviral monotherapy may represent a reasonable initial therapeutic strategy in select patients with biopsy-proven MCD and active hepatitis B infection.
SN - 0304-5412
SN - 1536-5964
ER -