Hepatitis-B virus (HBV) infection, which was a cause of childhood nephrotic syndrome, was reported in many areas of the world, especially in endemic regions. The clinical features, outcome and treatment of HBV related nephrotic syndrome were quite different compared to idiopathic childhood nephrotic syndrome. Fifteen cases with serum HBsAg positive and nephrotic syndrome at Nephrology Department, Children's hospital No.1 were enrolled in a retrospective study from January 2009 to May 2011, Mean age at onset was 8.5 years ( 2-14 years ), 60 percent of cases were after the year of ten. Male was predominant (11/15). Clinical findings included: hypertension 20 percent, microscopic hematuria 80 percent, macroscopic hematuria and renal failure at diagnosis 0 percent. Serum ALT, AST were in normal level in 100 percent of cases. All patients had serum HBsAg+/HBsAb-. Of 14 cases, serum HBV-DNA titer above 105 copies/ml was observed in 13. Lamivudine resistant HBV genotype B was present in 7 of 8 cases. Four types of lesions were observed on renal biopsy: membranous glomerulopathy, menbranoproliferative glomerulonephritis, focal segmental glomerulonephrits and minimal change disease with the rate of 26.7 percent, 26.7 percent, 13.3 percent and 33.3 percent respectively. Of ten cases treated with prednisone before HBsAg screening test, 6 was steroid resistant. Two patients gained complete remission following HBeAg+ seroconvertion to HBeAb+ after 17 and 25 months of treatment with Lamivudine. Newly diagnosed cases with nephrotic-syndrome should be performed HBsAg screening test to discover chronic HBV infection. Corticosteroid should be prescribed meticulously with a close evaluation the active replication of HBV in order to indicate an anti-viral agent appropriately.
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