HBV Infection And Hepatitis B Virus Associated Glomerulonephritis

Background:Since the discovery of the Australia antigen by Blumberg and Visnich in 1964,the cases of HBV infecton have been increasingly rising over the world.HBV is a kind of DNA virus,which belongs to hepadnavividae .It is a 42nm-sized sphere granule and called Dane partical which has an envelop and a core.The envelope is the hepatitis B surface antigen which thickness is 7-8nm. The core with 27nm diameter includes parts of double-chained and single-chained circular DNA, DNApolymerase, hepatitis B core antigen(HbcAg) and hepatitis B e antigen(HbeAg).That HBV can lead to other organs'lesions,such as different kind of glomerulonephropathy ,except hepatitis, liver cirrhosis and hepatocellular carcinoma has been confirmed. The detection of HbsAg in the kidney of a patient with membranous nephropathy was first reported by Combes in 1971 and HBeAg,HBcAg was found in kidneys one after the other in 1979 and 1980.Since then ,the researchers in many countries paid attension to the relationship between HBV infection and glomerulonephritis and have done more research work for it.Now,it is well accepted that HBV infection can lead to nephritis as a independent disease called hepatitis B virus associated glomerulonephritis(HBV-GN).But the pathogenetic mechanism of HBV-GN remains unclear.lt is suggested that HBV immune complexes play a main role in the pathogenesis of HBV-GN. That HBV may infect kidneys directly leading to nephritis is also another mechanism.There is a higher rate of HBV infection in our country and it's significant to make clear the relationship between HBV infection and HBV-GN.Obstractive:To investigate the relationship between HBV infection and hepatitis B virus associated glomerulonephritis and the correlations between hepatic lesions and renal lesions in HBV-GN patients.Method:Two hundred and eighty-one consecutive cases of HBVAg-positive and histologically proven glomerulonephritis seen at the laboratory of Pathology in Nanfang Hospital from April 1993 to September 2003 were involved in this studied.Mean age 29.03 + 14.05 years of age. One hundred and nighty-seven were male and eighty-four female.Eighty-nine patients among these cases were diagnosed hepatitis B associated glomerulonephritis and their serological investigations,pathological findings of renal and liver biopsies and laboratory results were analyzed.The histological lesions of kidneys were semiquantitatively determined according to Katafuchi.We examined the paraffin section of kidney biopsies for HBV-DNA using in situ polymerase chain reaction(PCR). The degrees of liver inflammation (G) and fibrosis(S) were respectively divided into 0~4 according to the plans for prevention and treatment of viral hepatitis in our country.Results:l.CIinical findings:Mean age at the time of biopsy of the eighty-nine HBV-GN patients was 26.20?5.13 years.Seventy were male and nineteen female. Mean age at the discovery of the kidney disease was 25.04 + 14.88 years.The mean duration of the disease ,approximated from the time of discovery to biopsy,was 18. 02 + 26. 85 months(88 cases).Among these patients,there were 48 cases with MN,with the rate of 53.9%. 16 cases with MsPGN(17.9%) and 9 cases with IgA nephropothy(10.1%).Six patients had clinicalmanifestation of hepatitis in the past.2.The relationship between HBV serology , viral replication and nephritis.(l).The incidence of HBV-GN in male(35.5%) was significantly higher than that in female(22.6%) in 281 HBVAg positive patients(p<0.05).(2).The incidence of HBV-GN in groups of HBeAg-positive or HBV-DNA levels more than 105 copies/ml was significantly higher compared with groups of HBeAg-negative or HBV-DNA levels less than 105 copies/ml (p<0.001,p=0.001).(3).There was no significant difference between proteinura, creatinine clearance and renal pathological changes in groups of HBeAg-positive or HBV-DNA levels more than 105 copies/ml and groups of HBeAg- negative or HBV-DNA levels less than 105 copies/ml.3. The relationship between renal deposition of HBV and renal pathological changes.