Analysis Of Clinical And Pathological Characteristics Of Hepatitis B Virus-associated Glomerulonephritis

Objectives:To analyze the clinical,pathological and laboratory characteristics of patients with hepatitis B virus-associated glomerulonephritis(HBV-GN),compare the characteristics of HBV-GN with different clinical manifestations and different serological HBsAg status,so as to improve the understanding of HBV-GN and find new observation indicators for diagnosis and treatment.Methods:The retrospective analysis was performed on 96 patients with HBV-GN who underwent renal biopsy in the First Hospital of Jilin University from October 2010 to December 2019 and met the diagnostic criteria formulated in the symposium on " hepatitis B virus-associated glomerulonephritis" held in China in 1989.SPSS19.0 software was used to establish the database and conduct statistical analysis to compare the general situation,pathological types,serological Hepatitis B virus(HBV)markers and laboratory data according to different clinical manifestations and different serological HBsAg status.Results:1.From October 2010 to December 2019,a total of 3598 patients underwent renal biopsy in the First Hospital of Jilin University,among which 96 were diagnosed as HBV-GN,accounting for 2.7% of the renal biopsy in the same period.Among them,there were 68 males and 28 females,male: female =2.43:1,the mean age was 43.86±15.07 years old.37.5% of the patients had a history of hepatitis B,and 62.5% of the patients had renal disease as the first symptom.2.Among the 96 patients,49 were HBsAg positive and 47 were HBsAg negative,among which 9 were serologically negative.There were 36 cases with high viral load,accounting for 37.5%.All patients had proteinuria,4.2% had macroscopic hematuria,89.6% had dominant edema.Nephrotic syndrome(NS)was observed in 79.2% and nephritis syndrome in 20.8% of the patients.Transaminase increased in 24 cases,accounting for 25.0%.The glomerular filtration rate decreased in 14 cases,accounting for 14.6%.3.There were 3 pathological types of the 96 patients with HBV-GN,followed by membranous nephropathy(MN)in 87 cases(90.6%),membranoproliferative glomerulonephritis(MPGN)in 6 cases(6.3%)and IgA nephropathy in 3 cases(3.1%).Pathological immunofluorescence revealed multiple immunoglobulins and complements deposition,among which 23 cases(24.0%)showed “full-house” immunofluorescent staining.4.The 96 patients were divided into NS group(76 cases)and nephritis syndrome group(20 cases)according to clinical manifestations.HBV-MN was the main pathological type in both groups,and the distribution of IgA nephropathy in nephritis syndrome group was higher than that in NS group(P<0.05).Compared with nephritis syndrome group,patients in NS group had lower level of serum IgG(P<0.01),lower positive rate of serological HBsAg and Hepatitis B virus e antigen(HBeAg)(P<0.05),higher deposition rate of IgG in kidney tissue(P<0.05),the proportion of patients with “full-house” immunofluorescent staining in renal tissue of two groups had no statistically significant difference(P>0.05).Compared with nephritis syndrome group,NS group had lower level of serum Alanine aminotransferase(ALT),total protein,albumin,globulin,total bilirubin,direct bilirubin,indirect bilirubin and total bile acid(P<0.01),lower level of serum Aspartate aminotransferase(AST)(P<0.05),higher level of serum total cholesterol,triglyceride,24-hour urine protein quantification and 24-hour urine microalbumin quantification(P<0.01)and higher level of serum cholinesterase and Low density lipoprotein(LDL)(P<0.05).There was no statistically significant difference in the level of serum creatinine,serum uric acid,high density lipoprotein(HDL),the proportion of patients with High viral load and estimated glomerular filtration rate(eGFR)of two groups(P>0.05).5.The 96 patients were divided into HBsAg-negative group(49 cases)and HBsAg-positive group(47 cases)according to their serological HBsAg status.HBV-MN was the main pathological type in both groups,and the distribution of HBV-MPGN in HBsAg-positive group was higher than that in HBsAg-negative group(P<0.05).All 6 patients with HBV-MPGN were serologically positive for HBsAg,HBeAg and anti-HBc and had high viral load.Compared with the HBsAg-positive group,HBsAg-negative group had lower serum IgG level(P<0.01),higher C4 level(P<0.01),higher C3 level(P<0.05),lower renal IgM,C1 q deposition rate and lower proportion of renal tissue “full-house” immunofluorescent staining(P<0.01),and lower renal IgA and C4 deposition rate(P<0.05).Compared with HBsAg-positive group,HBsAg-negative group had lower level of serum indirect bilirubin(P<0.05),lower proportion of patients with high viral load and lower level of AST,ALT,total protein,globulin,total bilirubin,direct bilirubin and total bile acid(P<0.01),higher level of 24-hour urinary protein quantitative,24-hour urine trace albumin,cholinesterase and triglyceride(P<0.05).There were no statistically significant differences in the level of serum creatinine,serum uric acid,eGFR,albumin,cholesterol,LDL and HDL between the two groups(P>0.05).Conclusions:1.In this study,the patients with HBV-GN were mostly males.Membranous nephropathy was the main pathological type.Immunofluorescence showed the deposition of various immunoglobulin and complement,and the deposition rate of IgG was the highest,the “full house” can be observed.In some patients,all serological HBV markers were negative,but HBV markers could be detected in renal tissue.Routine staining of HBV markers was recommended for renal biopsy.2.In this study,the pathological type of HBV-GN was correlated with clinical manifestations and serological HBsAg status.The main clinical manifestation of HBV-GN patients with IgA nephropathy was nephritis syndrome.Serological HBsAg positive patients,especially patients with serological HBsAg,HBeAg and anti-HBc positive were more likely to develop HBV-MPGN.3.Serological HBsAg,HBeAg positive rate and liver inflammation activity are lower in HBV-GN patients presenting with NS than those presenting with nephritis syndrome.Considering the actual long course of HBV infection in HBV-GN patients presenting with NS,attention should be paid to the presence of proteinuria and hypoproteinemia in HBV-GN patients,even if the NS level has not been reached.4.Compared with serological HBsAg-negative patients,HBsAg-positive patients had lower level of serum complement and urine protein quantification,higher inflammatory activity in liver tissue and a higher proportion of "full house" in renal tissue.