Hepatitis B Virus-Associated Nephropathy

Abstract

A direct causal association between hepatitis B virus (HBV) infection and the development of nephropathy remains controversial. Epidemiological studies have shown that chronic carriage of HBV in some individuals (particularly children) leads to the development of nephrotic syndrome with a strong male predominance, the commonest histological type being membranous nephropathy (MN). Spontaneous clearance of HBV antigens (particularly the HBeAg) leads to abrogation of proteinuria. The isolation of immune complexes in the kidney suggests that the pathogenesis of the disease may have an immune-complex basis. Recent studies showing expression of HBV viral antigens in kidney tissue suggest direct viral-induced pathological alterations and chronic immunologic injury. Biosocial studies have detected no correlation between HBV carriage and proteinuria using both quantitative and qualitative urinary protein analysis. Genetic studies of HLA class I and II genes showed a predisposition to MN but no similar correlation in those with milder degrees of proteinuria. These findings suggest that milder proteinuria is unrelated to HBV carriage or genetic factors but the development of nephropathy, particularly MN, in patients with chronic HBV carriage (HBsAg and/or HBV DNA positive) is based on an interaction of virus and host factors. Although the natural history of the disease tends to remission with preservation of renal function, there is considerable morbidity and a small but significant mortality. Use of naturally occurring cytokines (such as interferon-α2b) and other candidate therapies accelerates clearance of the virus and proteinuria. The most effective tool in reducing the incidence of the disease is the use of HBV vaccines.

A comparison of major histocompatibility complex SNPs in Han Chinese residing in Taiwan and Caucasians

“…cgi), and MHC studies [9,11,18]. Comparing the prevalence of inherited diseases in Han Chinese and Caucasian populations, atherosclerosis related to AIF1 and psoriasis related to C6orf18 are more prevalent in Caucasians [26,27]; allopurinolinduced severe cutaneous adverse reaction related to BAT3 [18] and hepatitis B virus related to HLA-DRA are more prevalent in Han Chinese [28,29]. Furthermore, we also investigated genomic regions highly linked to the 101 SNPs and found that some are related to the etiology of diseases such as nasopharyngeal carcinoma, which is highly prevalent in Asian populations.…”

Efficacy of adefovir dipivoxil combined with a corticosteroid in 38 cases of nephrotic syndrome induced by hepatitis B virus-associated glomerulonephritis

“…The less aggressive pathological types include IgA nephropathy, minimal change disease, crescentic glomerulonephritis and focal segmental glomerulosclerosis. 4 There is no standardized effective treatment for HBV-GN to date. Lamivudine, a type of cytosine nucleoside analogue, can effectively suppress RNA reverse transcriptase.…”

A case of anti-GBM glomerulonephritis superimposed on HBV-associated membranous nephropathy

“…MN is a well-recognized extrahepatic manifestation of chronic infection with HBV [1]. While primary MN is evoked by antibodies reacting to planted, endogenous, podocyte-related antigens, recently demonstrated to be the M-type phospholipase A 2 receptor (PLA 2 R) [31,32], the presence of immune complexes in the kidney suggests an immune complex basis for HBV-associated MN [1].…”

“…While primary MN is evoked by antibodies reacting to planted, endogenous, podocyte-related antigens, recently demonstrated to be the M-type phospholipase A 2 receptor (PLA 2 R) [31,32], the presence of immune complexes in the kidney suggests an immune complex basis for HBV-associated MN [1]. There are three principal antigens implicated in the pathogenesis of HBV-associated MN.…”

“…Although the pathogenesis of this association is unclear, immune complex deposition has been implicated [1]. Antiviral treatment with interferonalpha (IFN-a) and lamivudine has been reported to be beneficial [2,3].…”