POS-064 HEPATITIS C3 GLOMERULOPATHIES: CASE PRESENTATION OF TH THERAPEUTIC CARE

Abstract

Isolated C3 glomerulonephritis (CNG3) are rare glomerulopathies defined by the presence of glomerular deposits visible in OM and containing C3 complement deposits, without immunoglobulin IF deposits. These deposits are usually secondary to an impairment of the alternative complement pathway. We report the case of an infection with hepatitis B virus associated with membranous proliferative glomerulonephritis with C3 deposits. It's a rare entity that poses a real problem since there is no well-established consensus faced to th therapeutic emergency. CASE DESCREPTIVE PRESENTATION We present the case of 52 years old aged man, hypertensive and followed for chronic renal failure for 4 years, poorly observing therapeutic, his causal nephropathy was not yet identified. He was referred by his GP for rapid worsening of his renal function with creatinine numbers ranging from 172 micro moles in May to 342 in early August to 476 at the end of August and 625 in early September 2019 with high blood pressure figures. Two-cross proteinuria and hematuria with proteinuria at 3 grams / 24 hours were noticed. Faced with this rapid worsening of renal function, the patient received a renal biopsy puncture that showed a membrano-proliferative glomerulonephritis with isolated c3 depositis. An etiological assessment was carried out with a viral serology which was in favor of active hepatitis B with positive HBs antigen with 3150 viral load. The C hepatitis and HIV serologies were negative. In addition, the C3 complement fraction was consumed and anti-DNA, anti-nuclear, anti-neutrophil cytoplasmic were negative. It was probably a membranous proliferative glomerulonephritis with C3 deposits secondary to infection with the B hepatitis virus. The patient was initially treated with Entecavir, then with corticosteroid therapy containing solumedrol bolis 500 mg for three days followed by full dose steroids. The evolution was marked by a dependence on dialysis, then, after a short delay in starting intensive coticotherapy, the patient developped a fulminant B hepatitis with a pleuro-pericarditis which led to the death of the patient. This is a rare association of HBV infection and GNC3 that has not well responded to treatment. The search for renal HBV DNA is ongoing. The response to treatment had not been observed because of the appearance of fatal secondary complications of high dose of corticosteroid therapy.The dilemma is to find the best approach to treat and save these patients witch vital and a renal prognosis are threatened