Study Of Intrarenal Vascular Lesions In Hepatitis B Virus-associated Glomerulonephritis

【Objective】1. To analyze the prevalence, characteristics and influencing factors of renal vascularlesions in HBV-GN.2. To analyze the renal vascular lesions influence on HBV-GN patients’ clinicalmanifestations and pathological changes, explore the role and significance of renal vascularlesions in the progression of HBV-GN.3. To observe renal interstitial microvascular changes in HBV-GN when renal arterylesions in varying degrees, investigate the relationship between interstitial microvascularchanges and tubulointerstitial lesions, discuss the significance of C4d deposition in interstitialcapillary wall.【Methods】1. The clinical and pathological data were analysed retrospectively in299cases ofHBV-GN, renal biopsy tissue vascular lesions were observed with double-blind method. Asemi-quantitative scoring system was used to assess the severity of vascular lesions, fourdistinguished degrees from none, mild, moderate to severe were used. Then the correlationamong vascular lesions, clinical symptoms and pathological data was analyzed.2.70HBV-GN patients were assigned randomly to detect expression of CD₃₁anddeposition of C4d in renal biopsy by using immunohistochemical method（EliVision）. Theaccumulated areas of renal interstitial microvascular which marked by CD₃₁werequantitatively analysed by Image-Pro Plus Version6.0. The tubulointerstitial lesions werecompared among different groups which were divided by deposition site of C4d in renal tissue.【Results】1. Of the299HBV-GN patients, vascular lesions can be found in208cases （69.6%，mildin15.4%, moderate in47.2%and svere in7.0%）.Common pathological types include wall thickening, hyalinization, fibrosis and onion skin change. Afferent artery, interlobular arteryand arcuate arteries all could be involved. There was a significant difference of vascular lesionsprevalence and severe vascular lesions percentage between the patients with CKD1-2stage andthe patients with CKD3-5stage. Different pathological types had different prevalence ofvascular lesions in the renal tissue, SGN, FsGs highest, MCD/FsPGN lowest. Univariateanalysis showed that age＞18, hematuria, Scr＞132.6μmol/l, area of global glomerularsclerosis≥50%，balloon adhesions, cresent, interstitial fibrosis, tubular lesions more than2leveland the immune complexes deposited in capillary loops and mesangium had a significantinfluence on vascular lesions. Multivariate logistic regresion analysis showed that balloonadhesions, interstitial fibrosis and the immune complexes deposited in capillary loops andmesangium were independent risk factors of vascular lesions.2. Compared to those without renal vascular lesions,the mean age of patients with renalvascular lesions was elder, clinical manifestation showed more severely also, they had higherlevel of blood pressure and serum creatinine, but lower haemoglobin. The proportion ofpatients that eGFR <60ml/min gradually increased with aggravating small artery lesions. Thepathological types of those without renal vascular lesions commonly were MCD/FsPGN、MsPGN and MN, however, the pathological types with severe renal vascular lesions commonlywere SGN and MPGN. For the pathological changes, those with renal vascular lesions had ahigher incidence of glomerular sclerosis≥50%, cresent, balloon adhesions, tubulointerstitiallesions and immune complexes deposited in capillary loops and mesangium.3. The expression of CD₃₁in70patients showed that cumulative area of interstitialmicrovascular reduced accompanying renal vascular lesion exacerbation. Cumulative areas ofinterstitial microvascular among severity, none,mild, moderate and severe patients were23345±10123，26695±11826，18223±9384,16301±9538, respectively （P＜0.05）, whilesemi-quantitative scores of tubulointerstitial lesions were1.31±1.49，1.69±1.18,3.36±1.73,5.85±1.21respectively（P＜0.01）.There were31cases （44.3%）with no C4d deposition in renaltissue,39cases were positive. Among those patients,C4d deposition in interstitialmicrovascular wall was detected in12cases, C4d deposition only in glomerulus was detectedin other patients. 【Conclusion】1. The prevalence of renal vascular lesions in patient with HBV-GN was high（69.6%）,balloon adhesions, interstitial fibrosis and the immune complexes deposited in capillary loopsand mesangium were independent risk factors of vascular lesions.2. In patients with HBV-GN, vascular lesions parallel the severity of clinical andpathological changes. It reflects that vascular lesions can be used as an bad outcomehistological indicator in HBV-GN.3. The interstitial microvascular injured early in patients with HBV-GN, decreasing ofinterstitial microvascular can exacerbate tubulointerstitial lesions. It has different meaning thatC4d deposits in interstitial microvascular or in glomerulus.C4d deposition in interstitialmicrovascular can aggravate tubulointerstitial lesions also.