Analysis Of Clinical And Pathological Of Hepatitis B Virus-Associated Glomerulonephritis In 35 Children

Objective To investigate the clinical and pathological features of hepatitis B virus associated glomerulonephritis(HBV-GN)in children, and to help for diagnosis and treatment.Methods Retrospective analysis of the clinical manifestation, laboratory examination, pathological data, treatments and follow up data of 35 children had undergone renal biopsy diagnosed as HBV-GN, from January 2003 to December 2013 in the First Affiliated Hospital of Guangxi Medical University.Results (1)There were 24 males (68.6%) and 11 females (31.4%) in the group. The ratio of boys to girls was 2.2. Their age very from 3.5～16 years. The patients’ mean age was (10.3+3.4) years.(2)The clinical manifestations included with nephrotic syndrome (25 cases,71.4%), proteinuria and hematuria (8 cases, 22.9%), and isolated proteinuria (2 cases,5.7%).(3) Serum HBV markers: HBsAg+HBeAg+HbcAb positive (24 cases,68.6%), HBsAg+HBcAb+HbeAb positive (9 cases,25.7%), HBsAg+HBeAg positive (1 case,2.9%), HBsAg+HBeAg+HBcAb+HbeAb positive (1 case,2.9%). (4)The pathological classification included membranous nephropathy (MN) (25 cases,71.4%), focal segmental glomerular sclerosis (FSGS) (5 cases,14.3%), mesangial proliferative glomerulonephritis (MsPGN) (2 cases,5.7%), endocapillary proliferative glomerulonephritis (EnPGN) (2 cases,5.7%), Minimal change disease (MCD) (1 case,2.9%). (5) Immunofluorescence results showed multiple immune compound deposits, hepatitis B viral antigens was detected in the glomerular(27 cases,77.1%).19 cases (54.3%) of renal tissue immunofluorescence showed "full-house"(IgG、IgM、IgA、C3、C4、C1q were positive). (6)Correlation analysis: The different serum markers of hepatitis B viral positive, renal tissue markers of hepatitis B virus positive had no significant difference. There was no significant difference between pathological types in different clinical manifestations. Renal tubular and interstitial have or without lesions, renal tissue markers of hepatitis B virus positive between the groups, with statistically significant difference. (7) 23 patients followed up, only symptomatic treatment(7 cases,30.4%), effective (4 cases,57.1%), invalid (1 case,14.3%), deterioration (2 cases,28.6%). Only antiviral treatment (3 cases,13%), effective (2 cases,66.7%), invalid (1 case, 33.3%). Antiviral treatment combined with hormone(13 cases,56.5%), effective (6 cases,46.2%), invalid (7 cases,53.8%). Accompanied with renal tubular and interstitial lesions(15 cases,65.2%), effective (40.0%),No renal tubular and interstitial lesions(8 cases,34.8%), effective (75.0%). Renal tubular and interstitial have or without lesions, Efficacy between the groups, with statistically significant difference (P< 0.05). Efficacy and renal tubular and interstitial lesions correlation coefficient-0.422, P<0.05.Conclusions Most of the patients with HBV-GN are boys, the clinical manifestations and pathological changes are varied. The most common clinical manifestations were nephrotic syndrome, the most common pathological type as membranous nephropathy. Diagnosis depends on renal biopsy, and the antigens of hepatitis B virus is positive in children with abnormal urine, renal biopsy should be done as early as possible to confirm the diagnosis. Clinical manifestations and pathological type had no significant correlation, efficacy and renal tubular and interstitial lesions were negatively related. More than 50% children can be spontaneous remission, antiviral therapy alone may be superior to combined hormone therapy, children accompanied with renal tubular and interstitial lesions are poor prognosis.