Entecavir-induced Tubulointerstitial Nephritis

Korean Journal of Nephrology 2010;29(4):504-508.

Eun-Jin Han, M.D.1, Sun-Mi Kim, M.D.1, Hong-Sub Lee, M.D.1, Sung-Chan Jeon, M.D.1, Yun-Jung Jung, M.D.1, Hyunee Yim, M.D.2, Sung-Won Cho, M.D.1, Heungsoo Kim, M.D.1 and Gyu-Tae Shin, M.D.1

Department of Internal Medicine¹
Department of Pathology²
Ajou University School of Medicine

증례 : 엔테카비어 사용 후 발병한 세뇨간질성 신염

한은진1 , 김선미1 , 이홍섭1 , 전성찬1 , 정윤정1 , 임현이2 , 조성원1 , 김흥수1 , 신규태1

아주대학교 의과대학 내과학교실1 , 병리학교실2

Abstract

Acute interstitial nephritis is an important cause of acute kidney injury and most often induced by drug therapy. Entecavir is a potent antiviral agent approved for chronic hepatitis B. The antiviral therapy in chronic hepatitis B management is important because it reduces viral replication and liver injury, prevents development of complications, such as liver cirrhosis and hepatocellular carcinoma, and thus improves patient’s survival. The advantage of entecavir is its safety profile, particularly in patients with renal dysfunction. Although doses of entecavir are needed to be adjusted for patients with renal dysfunction, there has been no known renal toxicity of the drug itself. Here we report a patient with chronic hepatitis B and normal renal function who developed acute kidney injury due to tubulointerstitial nephritis after 10 months of entecavir therapy. Renal biopsy showed not only acute changes of interstitial nephritis such as marked cortical infiltration with lymphoplasma cells and neutrophils, mesangial matrix expansion, eosinophilic granular casts and degenerative epithelial cells within tubular lumen but also chronic changes, minimal tubular atrophy and interstitial fibrosis. After immunosuppressant therapy with steroids and mycofenolate mofetil, the patient’s renal function improved.

Key Words: Entecavir, Chronic hepatitis B, Interstitial nephritis, Adverse effects