공무원 검진 초진 환자, B형 간염 환자에서 단백뇨 소견, 추적 병원에서 알고 있겠지?만... - 동대문구 답십리, 전농동, 우리안애 우리안愛 내과

50대 후반 여자, 초진

공무원검진위해 내원

소변에서 아래와 같이 혈뇨 2+, 단백뇨 2+로 뚜렷

다시 문진해보면

B형 간염으로 **대학교에서 항바이러스 투약중

이전 검진에서도 단백뇨 얘기

**대학교에서 소화기, 간내과에서 6개월마다 정기검진중

결과 발부시 재검

같은 결과

생각되는 단어는?

HBV-associated nephropathy

Epidemiological data indicate that HBV-associated MN accounts for approximately 60–70% of HBV-associated nephropathy cases, particularly in adults [26]. MPGN accounts for nearly 30% of HBV-associated nephropathy cases [27] and is marked by mesangial cell and matrix proliferation accompanied by immune complex deposition [28]. This form often progresses rapidly, leading to renal insufficiency [29, 30]. MesPGN is relatively more common in children, usually presenting with mild proteinuria and microscopic hematuria [31]. While most pediatric patients with MesPGN have a favorable prognosis, some cases may progress to chronic kidney disease [32].

Targeting hepatitis B virus-associated nephropathy: efficacy and challenges of current antiviral treatments | Clinical and Experimental Medicine (springer.com)

The clinical manifestations of HBV-associated nephropathy are diverse, with common symptoms including heavy proteinuria, microscopic hematuria, hypertension, and gradually declining renal function. 임상적 증상은 다양한데... 많은 단백뇨, 미세혈뇨, 고혈압, 점점 감소하는 신기능

조직검사를 해야 진단이 되는데...

A presumptive diagnosis of HBV-associated renal disease can be made in HBsAg-positive patients with biopsy-proven membranous nephropathy, MPGN, or PAN [1,2], particularly if the patient is a child from an endemic area or an adult without another identifiable cause for the renal disease. Such patients are often HBeAg positive. However, confirming the etiologic role of HBV in any of these disorders may, at times, be difficult since the detection of viral antigen deposition in the kidney requires techniques that may not be available in many clinical settings. In addition, the presence of viral antigens in the renal tissue may be coincidental rather than indicative of a causal relationship [6]. Proof that HBV is the primary cause of the renal disease can only be provided by improvement in the renal disease with antiviral therapy and viral suppression.

B형 간염 관련이라고 진단이 중요한 이유는 보통의 사구체 신염에 사용되는 스테로이드나 면역억제제의 경우 항바이러스제 없이 사용하면 간염의 악화를 유발할 수 있기 때문이다.

Diagnosing HBV-associated renal disease is important because therapy with glucocorticoids and cytotoxic agents, which are common therapies for primary forms of the above disorders, may not be beneficial in patients with HBV-associated renal disease and may lead to reactivation of HBV replication, hepatitis flares, and liver failure if used without antiviral therapy.

Immunosuppression and plasmapheresis in select patients — For most patients with HBV-associated renal disease, treatment with antiviral therapy alone is sufficient. However, immunosuppression, with or without plasmapheresis, in combination with antiviral therapy may be beneficial in patients who have:

●RPGN

●PAN with severe manifestations

Except for these two indications, data from observational studies suggest that immunosuppressive therapy with glucocorticoids or cytotoxic agents and plasmapheresis are of little benefit and are potentially harmful. 위에 2가지 경우를 제외하고 면역억제제의 효용은 없다고...

환자는 조직검사등 받은적은 없으며 다른 국가검진에서도 단백뇨 얘기를 들었는데, 투약하는 대학병원에서도 같은 결과일거 같은데 설명이 없었을 뿐이 아닐지?

진행하는 신기능 저하가 없으면 현실적으로 항바이러스제만 투약하고 관찰하는 것 같으며, (조직검사 없이) 실제로 그렇게 보고 있는거 같다.

업무에 지장은 고용주가 판단하면 되므로 공무원 검진은 형식에 가깝다.

동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연

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