Clinical And Pathological Features Of HBV-GN And Acute Glomerulonephritis Which Perform Capillary Endothelial Proliferation

【Object】To explore the clinical and pathological features of cases of HBV-GN and ac- ute glomerulonephritis. HBV-Ag and HBV DNA positive rate in the kidney of HBV-GN and acute glomerulonephritis which perform capillary endothelial pr- oliferation.【Method】The cases of HBV-GN(n = 10) and acute glomerulonephritis (n = 10) which perform capillary endothelial proliferation were collected. The clinical manif- estations, pathology and treatment effects were compared. Serum hepatitis B virus antigen, nucleic acid were detected. Hepatitis B virus antigen was det- ected in renal tissue samples by light microscopy, immunohistochemistry and electron microscopy partly. Glomerular microdissection ,extraction of glome- rular DNA, PCR and sequence Determination.【Results】1. clinical manifestations①Group of hepatitis B virus associated glomerulonephritis No obvious incentive was prior to the onset and acute glomerulonephritis syndrome were common. Acute kidney injury is common.Oliguria, hypertension,lower hemo- globin was rare.②Group of acute glomerulonephritis Many incentivs were prior to the onset significantly and acute glomerulonephritis syndrome were common. Oliguria, hypertension, lower hemoglobin was common.③AGN group compared with HBV-GN group before treatment: SBP: P = 0.04; DBP: P = 0.06; Albumin: P = 0.919; Hemoglobin: P = 0.003; 24-hour urine protein: P> 0.05.2. Pathology①Group of hepatitis B virus associated glomerulonephritis Renal biopsy tissue of 9 cases was HBsAg-positive by light microscopy; 3 case was HbcAg-positive,2 cases was HBsAg-positive and HBcAg-positive. HBsAg and HBcAg were deposited mainly in the glomerular mesangial lesion area and lesion blood vessels, some can be found in interstitial straight small vessel, capillary between the tubular, tube wall, and small artery②Group of acute glomerulonephritis Renal biopsy tissue of 10 cases was HbsAg-negative and HBcAg-negative by light microscopy.③Group of hepatitis B virus associated glomerulonephritis Capillary endothelial cells proliferate globally diffuse, electron-dense material was deposit in subepithelial ,subendothelial and mesangial area multisitely. IgG, IgM, IgA, C3, C4, C1q were positive, "Full bright" was common.④Group of acute glomerulonephritis Capillary endothelial cells proliferate globally diffuse, electron-dense material was deposit in subepithelial and mesangial area multisitely. IgG, IgM, IgA, C3, C4, C1q were positive, "Full bright" was rare.3.Serum markers of HBV infection①Group of hepatitis B virus associated glomerulonephritis Serum HbsAg of 10 patients was positive and serum HBsAb was negative; serum HbeAg of 9 cases was positive, 1 case was positive-serum HBeAg and negative-serum HbeAb; serum HBcAb of 10 cases was positive.②Group of acute glomerulonephritis Serum HBsAg of 10 patients was negative; serum HBsAb of 5 cases positive; 9 cases expressed negative serum HbeAg ,HbeAb and HBcAb. 1 case espressed negative-serum HBeAg, HBeAb and positive-serum HBcAb.4. Detection of viral nucleic acid glomerular microdissection Group of hepatitis B virus associated glomerulonephritis HBV DNA was detected in the glomerulars of 9 biopsy tissue sections. PCR products were directly sequenced and confirmed a fragment of HBV DNA with primer. 5.Treatment:①Group of hepatitis B virus associated glomerulonephritis 2 cases were markedly effective ,5 cases were effective, 3 cases were in- valid. Before and after treatment: SBP: P=0.208; DBP: P=0.313, albumin: P=0.488; hemoglobin: P =0.046; 24-hour urinary protein: P> 0.05.②Group of acute glomerulonephritis 6 cases were markedly effective ,4 cases were effective, 0 cases were in- valid. Before and after treatment:; SBP: P =0.02; DBP: P =0.035, albumin: P 0.007; hemoglobin: P=0.000; 24-hour urinary protein: P> 0.05. HBV-GN group compared with AGN group after treatment: SBP: P=0.292; DBP: P=0.085, Albumin: P =0.043; hemoglobin: P=0.465; 24-hour urinary protein: P> 0.05.【Conclusions】1. The clinical symptoms (acute nephritic syndromes)of HBV-GN which perf- orm capillary endothelial proliferation is similar with acute glomerulonephritis which perform same type. The former was common in acute renal injury.The latter was common in oliguria, hypertension, lower hemoglobin. The clinical symptoms (nephrotic syndrome) of HBV-GN which membranous nephropat- hy and membranoproliferative nephropathy was different with it.2. HBsAg, HBcAg distribution of renal biopsy tissue was same in HBV-GN which perform capillary endothelial proliferative and HBV-GN which perform membranous nephropathy and membranoproliferative nephropathy . Both was same in HBsAg-positive rate. The former was low in HBcAg-positive rate ,3. HBV DNA can be detected in the glomerular of HBV-GN which perform capillary endothelial proliferative. Positive rate of renal HBV DNA was high.4. Compared by treatment of HBV-GN and AGN which perform capillary endothelial proliferation, the latter was significantly better than the former.