Clinical And Pathologic Characteristics In 18 Case Hepatitis B Virus Associated Glomerulonephritis With Serological Negative Marker Of Hepatitis B Virus

ObjectiveTo study clinical manifestations and pathological characteristics of serological negative Hepatitis B virus associated glomerulonephritis (HBV-GN).Materials and MethodsA retrospective study were carried out in 29 patients with HBV-GN and 74 idiopathic membranous nephropathy (IMN) by clinical manifestations and renal biopsy diagnosis in Peking University Shenzhen Hospital from January 2003 to March 2011. 29 patients with HBV-GN were devided into positive and negative group of HBV serological marker. The clinical manifestations and pathological features of three groups were compared.Results(1) In group HBV-GN with serological negative marker, Sex ration of the patients was 1.25:1 (man / female). There were 14 cases of nephritic syndrome (77.78%), 4 cases of chronic nephritis syndrome (22.22%). Proteinuria was mainly clinical manifestations. Serum positive rate of HBsAg, HBeAg, HBsAb, HBeAb and HBcAb was 0%,0%,61.11%,5.56%,16.67% respectively. Five patients'(45.46%) HBV-DNA was positive in the serology positive group and no person in the serology negative group. Renal pathology: 18 patients (100%) were membranous nephropathy (MN), 15 cases were atypical membranous nephropathy (83.33%), 3 cases were atypical membranous nephropathy (16.67%). Positive detection rate in pathological kidney tissues of HBsAg, HBcAg, HBsAg + HBcAg was 94.44%,38.89%,33.33% respectively. (2) Various immune-complex depositions were located in many spots with high intensity in the two groups of HBV-GN. No significant difference was found between the two groups in light and electron microscopy examination. The renal function impairment and hypo-complement C3 in the serologic positive group were more obvious than the serologic negative group (PCr=0.004, PC3=0.001). Statically difference in the level of complement C3 was found between subgroup all negative and subgroup only antibody positive of HBV markers in serologic negative groups (PC3=0.048). (3) The clinical manifestation of 74 patients with IMN was proteinuria, and of 64 (86.48%) patients was nephrotic syndrome. The changes of the level in serum creatinine and complement C3 of group HBV-GN with serologic positive was more obviously than group IMN (PCr=0.018,PC3=0.008). In 68 patients with IMN, immune complexes deposited in glomeruli was mainly IgG (100%) and C3 (73.5%). Compared with the patients of IMN, immune complex depositions of IgA, C1q and fibrinogen in group serological negative with HBV-GN were found signifincantly different, and that of IgG,IgM and C3 no different.Conclusions1. The main characteristics of serological negative HBV-GN were male in sex and MN, especial untypical MN in pathology.2. Compared with the renal function impairment and hypo-complement C3 of group serological negative and group positive HBV-GN, that of group postive HBV-GN were found significantly.3. To avoid missed diagnosis of HBV-GN, renal biopsy should be routinely detected in nephrotic syndrome and chronic glomerulonephritis syndrome patients whose serological markers of hepatitis B virus is negative.4. In our opinion, patients with serological markers of hepatitis B virus-negative or -antibody positive only, if positive HBV markers were detected in renal section, should be diagnosed HBV-GN..