Hepatitis B virus associated membranous glomerulonephritis.

Fourteen children with biopsy-proven membranous nephropathy associated with hepatitis B virus (HBV-MN) were evaluated biochemically and serologically and compared to 45 children with idiopathic nephrotic syndrome (INS). The mean ages of the two groups were similar (4.9 ± 1.6 vs. 4.6 ± 2.6 years). Serum albumin levels were similar in both groups, but serum cholesterol was significantly reduced in children with HBV-MN compared to INS. Serum C₃ was also significantly depressed in children with HBV-MN compared to INS, but no differences in C₄levels were noted. Serum alanine transaminase as well as aspartate transaminase concentrations were significantly elevated in children with HBV-MN compared to those with INS, suggesting the presence of chronic hepatitis in children with HBV-MN. Hepatitis B surface and e antigens were present in serum of all children with HBV-MN, but only 54% had circulating HBV-DNA particles demonstrable in their serum. Serum C₃ levels were higher in children with HBV-MN and circulating HBV-DNA, compared to those without circulating HBV-DNA. No other serological or biochemical differences occurred between these two groups. Glomerular deposition of IgG and C₃ occurred in 91% of children with HBV-MN; but IgM deposition appeared to occur more frequently and with greater intensity in those children positive for circulating HBV-DNA. Antibody to delta antigen was negative in all children with HBV-MN. We conclude that biochemical and serological differences can be identified between HBV-MN and INS. We also conclude that circulating HB viral DNA does not account for immune complex formation in HBV-MN but may be related to glomerular IgM deposition and that the delta antigen is not important in HBV-MN.

Section: Discussionmentioning

confidence: 83%

Biochemical and Serological Characteristics of Children with Membranous Nephropathy Due to Hepatitis B Virus Infection: Correlation with Hepatitis B e Antigen, Hepatitis B DNA and Hepatitis D

Milner¹,

Dusheiko²,

Jacobs³

et al. 1988

“…The glomerular changes were classified into 4 stages (stage I-IV) according to Ehrenreich and Churg [cited in 16]: stage I (2 cases), stage I-11 (2), stage II (20), stage 111 (10). Moderate mesangial cell proliferation with focal tubular atrophy and/or interstitial fibrosis was present in 18 children (52.9%).…”

Section: Pathologic and Immunohistological Featuresmentioning

confidence: 99%

Hepatitis B Virus-Associated Membraneous Nephropathy: Clinical Features, Immunological Profiles and Outcome

Lin¹

1990

To evaluate the clinical features, immunological profiles and the prognosis of hepatitis B virus-associated membraneous nephropathy (HBVMN), 34 patients (25 boys and 9 girls) were studied from April 1981 to November 1987. With Fab fragments of monoclonal antibodies, hepatitis B e antigen (HBeAg) was detected in the glomerular deposits from 30 cases (88.2%) and in the sera from 32 cases (94.1%). These results suggest that HBeAg plays an important role in the development of HBVMN. In addition, clinical trials of 32 cases demonstrate a relatively poor response to the steroid therapy with persistent heavy proteinuria (32.4%) or a high frequent relapse rate (38.2%); only 1 case (3.1%) had early response. In 4 cases follow-up renal biopsy was performed, progressive sclerosis with interstitial fibrosis being noted in each instance. The stage of membraneous nephropathy examined under the light microscope, had progressed from stage I or II to stage III. One had impaired renal function. Therefore, HBVMN does not always take a benign course. In the immunological profiles, significant hypocomplementemia with low C3, C4 and properdin factor B levels were found during the initial 6 months after the onset of disease. Hepatitis B surface antigen (HBsAg) circulating immune complexes (CIC) were also significantly higher. However, the levels of HBsAg CIC did not correlate with the degree of proteinuria or hematuria. In patients with persistent HBsAg carriage, serum HBeAg status alone did not correlate with remission rate, and remission occurred usually before the HBeAg seroconversion to anti-HBe. These results suggest that factors other than HBeAg play important roles in HBVMN.

“…This patient's clinical and morphological features showed no characteristic pattern when compared to cases with idiopathic MN. Although serum levels of both C} and C4 were low in this case, previous reports of a rela tionship between hypocomplementemia and HBV-asso ciated MN are not conclusive [12,13,[15][16][17]. The staging of the MN by electron microscopy correlated roughly with the duration of the disease.…”

Section: Discussionmentioning

confidence: 78%

“…Furthermore. Ito et al [8] and Wiggelinkhuizen et al [13] noted that the proteinuria cleared with seroconversion from HBeAg to anti-HBe in several patients with HBVassociated M N, suggestive of the etiologic role of H BeAg in maintaining active membranous changes in this case.…”

Section: Discussionmentioning

confidence: 91%

Hepatitis B e Antigen-Associated Membranous Nephropathy

Lee

Koh

1989

A case of hepatitis B virus (HBV)-associated membranous nephropathy (MN) is presented in an 18-year-old Korean male, whose renal disease had begun 9 years previously. He was positive for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and antibody to hepatitis B core antigen (anti-HBc) in the serum. By immunofluorescence, HBeAg staining was noted in glomerular deposits in association with IgG, C₃ and C_1q, while neither HBsAg nor HBeAg was found in the glomerular deposits. The presence of glomerular HBeAg staining by FITC-monoclonal anti-HBe F(ab’)₂ fragments has been reported before, but never in non-Japanese patients. The demonstration of HBeAg in both the glomerular deposits and serum in this case supports the causal relationship of HBeAg and HBV-associated MN.