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Implication for health policy/practice/research/medical education:In this case, the clinical history and morphologic lesions of kidney biopsy of a 38 year-old Afghan origin male are discussed. The patient presented with nephrotic syndrome and positive hepatitis B surface antigen (HBsAg). Renal biopsy was mostly consistent with membranoproliferative glomerulonephritis (MPGN) type I. Two months after prednisolone therapy, patient’s condition suddenly deteriorated and acute renal failure was found. The patient underwent dialysis. During evaluation, >2×107 IU/ml of viral DNA of hepatitis B was found. In the second biopsy, crescentic glomerulonephritis was evident. After adding lamivudine to the regimen, serum creatinine decreased and stabilized at 1 mg/dl. Patient was discharged in stable condition and the lamivudine was continued.

Sudden deterioration of renal function in a patient with nephrotic syndrome and a very high hepatitis B viral DNA load.