Clinical And Pathologic Features Of Hepatitis B Virus-Associated Glomerulonephritis

Background and Objectives:Hepatitis B virus (HBV) is a world-wide popular virus while there almost 1 billion people (more than 50 million people/year) have been infected by HBV. China is highly in prevalence of HBV and the rate of HBsAg carriage is as high as 10%-20%. The most common manifestation of HBV infection is acute and chronic hepatitis. Also chronic HBV infection can induce many immunity dysfunction and extrahepatic injuries. Approximately 20% chronic hepatitis patients have extrahepatic injuries and hepatitis B virus associated glomerulonephritis (HBV-GN) is the most common one. Due to the high incidence of HBV infection in China, HBV-GN has become a common secondary kidney disease in China. The pathogenetic mechanisms by which individuals with chronic HBV infection develop nephropathy are not well defined. The most accepted point is that immunological process induced the disease also acting with viral characteristics, genetic and environmental factors. Former studies have shown that HBV-GN is common in children and has a high rate of spontaneous remission. HBV-GN in children is different in clinical manifestation, pathology and prognosis comparing with adults. About 30% adult patients with HBV-GN would process into end-stage-renal-disease (ESRD). The knowing rate of HBV-GN is low and the diagnosis and treatment of is not quite standard. This study investigates the clinical and pathological features of HBV-GN and the relationship between HBV replication and the severity of the disease; the different between HBVMN and IMN basing on large-scale clinical and pathological data of HBV-GN. Providing evidences for elevating the diagnosis and treatment for HBV-GN.Methods:Collecting the clinic pathological and laboratory data of 205 patients with HBV-GN diagnosed by renal biopsy in PLA general hospital from 1989 to 2008. The diagnosis of HBVMN is in line with hepatitis B virus related glomerulonephritis diagnostic criteria developed by China in 1989:a) serum HBV marker positive; b) suffering from glomerulonephritis and lupus nephritis and other secondary glomerular disease have been excluded; c) presence of detectable glomerular hepatitis antigen or antibody (including HBsAg and HBcAb). Among them, rule 3 is most basically, there is no diagnosis for lacking this; the diagnosis of IMN biopsy is consistent with Ehrenreich standards. The patients got HBVDNA tests were divided into 4 groups by the content of HBVDNA in serum. SPSS is used to complete statistics analysis.Results:Among 205 patients with HBV-GN,157 (76.5%) were male, age of onset ranges from 3-65, mean age was 37.79 years-old.95(46%) patients break out with kidney disease.102(49.8%) present nephrotic syndrome,71(34.6%) present chronic nephritic syndrome,32(15.6%) patients suffered kidney dysfunction. Haematuria was the complicated syndrome in 155 patients (75.6%). Hypertension was found in 74(36.5%) patients. Patients with liver dysfunction got no different in clinic manifestation and renal pathology compare with those without liver dysfunction. MN is the most frequent pathological change and accounting for 60.5%(124).Patients with Membranoproliferative glomerunephritis is 28(13.7%), mesangial proliferative glomerunephritis is 53 (25.9%).With the rising of the content of HBVDNA in serum, the urinary protein increases, the plasma albumin, C3, C4 decreases; the impairment of glamorous in HBVMN aggravated, the impairment of interstitial and tubule in HBV-IgA nephropathy aggravated. With the rising of the content of HBVDNA in serum, the deposition of C4 in kidney increase.The patients with HBVMN are almost young or middle-aged and the onset age of HBVMN group is significantly younger than that of IMN group. The main performances of both groups are nephrotic syndrome. The occurrence of the hematuria and renal insufficiency in patients with HBVMN is significantly higher than that of IMN group. Hyperlipidemia in patients of HB VMN group are not as significant as that of IMN group. The decline of immunoglobulin IgG in HBVMN is not severe as IMN, the plasma complement C3, C4 are significantly decreased compared with IMN. The segmental glomerular damage and mesangial cell proliferation in HBVMN group are much more obvious than that of IMN group. The tubulointerstitial injury and intrarenal vascular lesions between the two groups are of no significant difference. Immunofluorescence examination shows that the deposition of C3, C4, C1q, fibrinogen (Fib) is more frequent in HBVMN group and "full-house" in HBVMN group is common too. The pathology of HBVMN patients is often associated with mesangial proliferation and segmental injury, immunofluorescence shows co-deposition of various immune proteins and complement.Conclusion:The peak incidence of HBV-GN is in the twentieth to forth decade of life. There was a 3:1 predominance of males. Nephrotic syndrome was the most common clinic manifestation and membranous nephropathy was the most common pathological change in HBV-GN.15%patients had loss of kidney function at the time of renal biopsy. With the rising of the content of HBVDNA in serum, the HBV-GN patients' clinic manifestation and pathology aggravated. HBVMN have the features of both membranous nephropathy and hepatitis B. So it is different in clinic and pathology with IMN. As the high rate of HBV infection in China, we need to prevention the kidney damage in HBV infectious people and elevate the early diagnosis and therapy.