Hepatitis B virus-associated nephropathy in black South African children

Abstract

Hepatitis B virus (HBV)-related membranous nephropathy (MN) is prominent in secondary nephrotic syndromes (NS) in Africa, but the features of this disease and the spectrum of associated glomerulopathies have not been adequately documented in black children. HBV was detected in 93 children with NS included in this study. In 70 patients the histological type was membranous; 46 were followed for a mean of 3.4 years (range 1-11 years). Spontaneous elimination of both HBsAg and HBeAg occurred in 10 (21.7%) patients; 16 (34.8%) cleared HBeAg alone. Co-existing liver disease occurred in 18 (25.7%) and hypocomplementemia (C3,C4) in 47.1% and 11.4% of children, respectively. Sixty-five (92.9%) patients had normal renal function, 1 (1.4%) impaired renal function, 3 (4.3%) chronic renal insufficiency, and 1 (1.4%) end-stage renal disease at last hospital visit. Twelve patients were in remission, all having cleared HBeAg. HBVMN was clinically indistinguishable from 24 children with idiopathic MN, although biochemical characteristics were different. This report delineates the natural history of HBV infection in black South African children with NS, the majority of whom have MN. Disease remission in HBVMN parallels elimination of HBV antigens, particularly HBeAg. Comparison of HBVMN with idiopathic MN revealed clinically indistinguishable characteristics but unexplained biochemical differences.

Hepatitis B Virus-Associated Nephropathy

“…In this cohort of patients, 37 (52.1%) of patients went into spontaneous remission, this was associated with HBeAg clearance in 33 patients (89.2%) over 90 months; the average time of clearance of HBeAg to remission was 5 months. A second report by Bhimma et al [1]of 93 children with HBV-associated nephropathy in black children in KwaZulu/Natal in South Africa showed 70 of the 93 patients to have MN with a pattern of disease similar to that reported from other regions in South Africa.…”

“…More recently, Bhimma et al [1]reported 6 (26%) of 23 children with HBV-associated glomerular disease other than MN to have mesangial proliferative glomerulonephritis. Circulating immune complexes, particularly large circulating immune complexes, are deposited principally in the mesangial regions and subendothelial space [51].…”

“…Brzosko et al [53]first described this pathological entity, and subsequent reports from other countries showed that the strongest association of chronic HBV carriage, particularly in children, is with MN [1, 7, 31, 33, 34, 35, 36, 37, 38, 39]. In children, HBV-associated membranous nephropathy (HBVMN) resolves spontaneously in many cases, usually in association with the appearance of free anti-HBeAb in the circulation [40, 41].…”

“…A variety of extrahepatic disorders, one of the commonest being hepatitis B virus (HBV)-associated nephropathy [1], may appear in persons chronically infected with HBV [2, 3, 4]. Immune complexes mediate most of these injuries [2, 3, 4].…”

Hepatitis B Virus Infection and the Kidney: Renal Abnormalities in HBV Patients, Antiviral Drugs Handling, and Specific Follow-Up

“…Membranoproliferative glomerulonephritis (MPGN) is characterised by the deposition of immune complexes in the mesangium and subendothelial spaces. Glomerular deposition of immunoglobulin G (IgG), complement C3, and HBsAg has been reported, with a predominant deposition of IgA in the renal mesangium in patients with HBV-associated mesangial proliferative glomerulonephritis [17,18]. Another mechanism is the so-called polyarteritis nodosa, a vasculitis affecting medium-sized arteries in most cases, which usually occurs within 4 months of HBV infection and affects the medium-sized arteries in most cases [19].…”