Management Challenge in a Known case of Chronic Kidney Disease on Immuno-Suppressive Agents Now Presenting with Acute Viral Hepatitis

Background: Tubulo-Interstitial Nephritis (TIN) is a nonsuppurative inflammatory disease of the kidney interstitium and if chronic, almost always progresses to Chronic Kidney Disease (CKD). Hemodialysis is frequently performed as renal replacement therapy. However, to treat the underlying cause of CKD, like in autoimmune cases immunosuppressive agents are needed in addition. Patients undergoing hemodialysis are at higher risk of developing blood borne infections such as HBV and HCV. Due to impaired immunity in CKD, TIN patients on immunosuppressive therapy becoming HBV infected, warrants a clear treatment limitation like withholding of immunosuppressants as the viral replication soars high, increasing the chances of developing chronicity and viral mutants. Anti-viral drugs are very helpful for HBV infection control in these patients. The purpose of this case report is to draw the clinicians' attention towards early diagnosis and management of HBV infection among such groups of CKD patients, as it can cause higher morbidity and mortality, if not appropriately addressed. Case Presentation: We report here a female of 37 years age suffering from CKD due to TIN, priorly on Maintenance Hemodialysis (MHD) for 3 months followed by immune-suppressive agents for next 3 months with evident clinical improvement. She suddenly developed silent deep jaundice and health deterioration with hepatitis B positivity and high viral load on testing. Antiviral administration and withdrawal of immunosuppressive therapy showed significant improvement over a short span of time. She was never vaccinated against Hepatitis B Virus (HBV) prior to or during her treatment. Conclusion: CKD patients on renal replacement with dialysis, immunosuppressants and steroid, acquiring HBV infection is a major concern. The aim here is to highlight few points for management aspects of HBV infection in such group of patients, which are not commonly, but should necessarily, be a part of the protocoled medical practice in our country. Moreover, prevention of infection by vaccination and infection control measure should be strictly followed. Chatt Maa Shi Hosp Med Coll J; Vol.25 (2); July 2026; Page 125-128