The Clinical And Pathologic Features And The Long-term Prognosis Of Hepatitis B Virus-associated Glomerulonephritis

?Objectives?1.To investigate the clinical and pathologic features of HBV-GN and the relationship between them and provide the evidences for the diagnosis and treatment of HBV-GN.2.To explore the long-term prognosis of HBV-GN and the related factors wich affect the long-term prognosis of HBV-GN.?Methods?1.The clinicopathological data of 413 cases of HBV-GN diagnosed by renal biopsy in our hospital from January 1994 to Decenber 2013 was collected and analyzed to investigate the clinical features and pathologic changes.2.302 cases of HBV-GN with enough information available were followed for no less than one year.The end point events was defined as the doubeling of serum creatinine level,end-stage renal disease(ESRD)and death.Survival analysis using Kaplan-Meier curve and the related factors of long-term prognosis were analysised by COX proportion of risk model.?Results?1.There were 298 male patients and 115 female patients in our study.The average age of patients who suffered HBV-GN was 29.0±12.8 year old.At the time of renal biopsy,patients with hypertension,hyperuricemia and liver dysfunction accounted for 21.8%,35.6%and 21.8%,respectively.15.6% of the patients presented with nephrotic syndrome was not accompanied by hyperlipidemia.Only 15.0% of the patients suffer from abnormal renal function,most of the patients were in the early stage of CKD.2.HBV-GN included four types of clinical manifestations: nephrotic syndrome,proteinuria with hematuria,simple proteinuria and simple hematuria,with the nephrotic syndrome being the most frequent type(47.5%).HBV-GN was divided into eight pathological types,including MN,IgAN,MsPGN,MPGN,MCD,FsPGN,FSGS and SGN,among witch MN was the most common type(32.0%).Severe pathological types,including SGN,FSGS and MPGN,accounted for 17.7%.3.Among the patients presented with nephrotic syndrome,MN was the most frequent pathological type.Among the patients presented with proteinuria and hematuria,IgAN was the most frequent pathological type.The pathological type of patients presented with simple hematuria was milder,with the absence of FSGS,SGN and MPGN.4.Mesangial proliferative,podocyte lesions and basement membrane lesions were found in 90.4%,62.0% and 59.8% of the patients,respectively.The immune complexes deposited mainly in the mesangial area(72.9%).A variety of immune complexes deposited in the renal tissues,and a variety of immune complexes were simultaneously observed in some patients,with 18.6% of the patients presented “full house”.The detection rate of C3 was higher than that of C4(P<0.001).The positive rate of HBsAg was 71.7%.The detection rate of HBsAg and HBcAg both positive was 23.5%.The detection rate of HBcAg positive was 4.8%.Most of HBV antigens deposited in the glomerulus(87.2%).There is no difference in clinical manifestation types and pathological types between different serological HBV markers(P1=0.518,P2=0.314).There is no difference in clinical manifestation types and pathological types between different types of HBV antigen deposition in renal tissue(P1=0.668,P2=0.132).5.The incidence of renal tubule interstitial lesions and intrarenal artery lesions in the patients presented with proteinuria and hematuria was higher than that in the patients presented with nephrotic syndrome(P<0.05),and the degree of renal tubule interstitial lesions and intrarenal artery lesions in the patients presented with proteinuria and hematuria was more severe than that in the patients presented with nephrotic syndrome(P<0.05).Different pathological types had different degrees of renal tubule interstitial lesions and intrarenal artery lesions(P<0.001).In the patients with severe pathological type,the incidence of renal tubule interstitial lesions and intrarenal artery lesions was higher,accompanied with more severe pathological changes.In addition,the degree of intrarenal artery lesions was positively correlated with the degree of renal tubule interstitial lesions(P<0.001,r=0.375).6.With a median follow-up of 60 months(range12?237months),there are 52 cases of HBV-GN reached end point events.The 3-year,5-year,10-year and 15-year renal survival rate of HBV-GN were 96.9%,88.8%,76.3% and 59.8%,respectively.7.Univariate analysis showed that pathological type,glomerulosclerosis,renal small artery lesions,tubule interstitial lesions,hypertension,hyperuricemia,eGFR,urine protein,glucocorticoid or immunosuppressant therapy,anti-virus therapy and short-term remmission were the influence factors of the long-term prognosis of HBV-GN.Multivariate COX regression analysis showed that hypertension,hyperuricemia and severe glomerular sclerosis were independent risk factors for the long-term prognosis of HBV-GN,while short-term remmission was a protective factor for HBV-GN.?Conclusion?1.The clinical manifestations and pathological changes of HBV-GN are varied,including 8 pathological types and 4 types of clinical manifestations.There is a certain association between clinical manifestations and pathological changes.Here,We come up with diagnostic classification scheme that based on the clinical pathology,namely,“8 pathological types-4 types of clinical manifestations”,providing the clinical evidencesfor the classification,diagnosis and treatment.2.The long-term prognosis of HBV-GN is poor.Hypertension,hyperuricemia and severe glomerular sclerosis are independent risk factors for the long-term prognosis of HBV-GN,while short-term remmission is a protective one.