Hepatitis B Virus Associated Glomerulonephritis Related Factors And Clinical And Pathological Study Of Hepatitis B Virus-associated Membranous Nephropathy

Objective:1. To clarify the relative factors of Hepatitis-B virus associated Glomerulonephritis (HBV-GN).2.To explore the defferenctial features in clinical presentation, renal patholgyan d glomreulardeposition of IgG subtypes amongHepatitis-B virus associated Membran ous Nephropathy(HBV-MN),Idiopathic Membranous Nephropathy(IMN)and Lupus Me mbranous Nephropathy.Method:Renal biopsy was performed in all patients at Peking Union Medical College Hospital from Jan1st,2001to Dec31st,2009. Part1:In the retrospective case-control study,86patients with HBV-GNand135HBV carriers with non-HBV-GNwere enrolled. Logistic regression analysis was used to observe the relative factors for HBV-GN.Part2:Totally,48patients with HBV-MN,100patients with IMN cases and31patients with LMN wererecruited to explore the difference in clinical presentation and pathological features among the three types of MN. IgG subtype staining was also performed by using immunohistochemical method in selected patients. Results:Part1:Results1.On univariate analysis, the factors associated with HBV-GN were as follows:male, HBeAg positivity, HBV replication, liver cirrhosis, and elevated alanine aminotransferase (ALT). On multivariate analysis, the associations remained significant for male, HBV replication, liver cirrhosis and elevated ALT.2.Compared with HBV-associated IgA nephritis (HBV-IgAN), the factors associated with Traditional HBV-GN(HBV-MN or HBV-MPGN) on univariate analysis were as follows:male, HBV replication, and elevated alanine aminotransferase (ALT). On multivariate analysis, the factors associated with Traditional HBV-GN were as follows:male and HBV replication.Part2:1. Average age of onset differed among HBV-MN, IMN and LMN groups (37±12vs.48±14vs.35±9, p<0.01).The patients with HBV-MN hada significant male predominance by comparing with those with IMN AND LMN (83%vs.54%vs.26%, p<0.01). Levels of serum complements in the patients with HBV-MN and LMN were higher than those with IMN(p<0.01).2. In renal pathology, theoccurrence of mesenterial hyperplasy and mesangial and subendothelial dense deposit were more frequent than those with IMN (p<0.01).3. hi renal pathology, the patients with HBV-MN had higher prevalence of IgGl positivity than those with IMN and LMN. In HBV-MN and LMN, IgG4predominated inglomerular IgG depositin, whereas in LMN, IgG3did.Conclusion: Male, HBV replication, liver cirrhosis and elevated ALT may be predictive factors for HBV-GN. Compared with HBV-IgAN, Traditional HBV-MN is significantly associated with male and HBV replication.Clinical presentation, pathological f eatures and the pattern of IgG subtype despostion may helpfor differential diagnosis among HBV-MN, IMN and LMN.