The clinical course of hepatitis B virus-associated nephropathy

Abstract

Hepatitis B virus (HBV) infection is recognised as an important cause of nephrotic syndrome in endemic areas. This paper retrospectively examines the natural history and treatment of 70 patients with membranous glomerulonephritis and 1 with mesangiocapillary glomerulonephritis associated with HBV infection. Thirty-seven patients were in complete remission by the end of the study. The average duration of proteinuria in these patients was 30 months. The cumulative probability of remission was 64% at 4 years and 84% at 10 years. Three patients were still nephrotic after more than 90 months of follow-up and 2 others had reached end-stage renal failure. Remission occurred within 6 months of clearing the antigen (HBeAg) in the majority of cases. Steroids alone were given to 10 patients and 2 received steroids and cyclophosphamide, with no beneficial effect. Three patients received interferon-alpha 2b. One cleared the HBeAg from the circulation and had a significant fall in proteinuria, but defaulted from follow-up a month after completing treatment. One had a reduction of proteinuria but remained HBeAg positive. There was no change in the condition of the third. Although the majority of children eventually enter remission, there is a significant morbidity associated with the disease. Steroids and other immunosuppressive therapy are of no benefit. Interferon therapy may be useful, but has not been adequately assessed.

Systemic abnormalities in liver disease

“…The diagnosis is based on an assessment of the status of HBV replication (HBeAg/Ab and HBV DNA levels) [126] , laboratory findings (urinalysis and liver function test) and a kidney biopsy, although it is sometimes difficult to detect the deposition of viral antigens in the kidney by routine immunohistochemical analysis. HBV-associated nephrotic syndrome due to membranous nephropathy is not uncommon in children, and spontaneous recovery has been reported, which is often associated with seroconversion of HBeAg to anti-HBe [127] . In adults, on the other hand, spontaneous resolution is relatively uncommon and antiviral therapy may be effective [128] .…”

Hepatitis B Virus-Associated Nephropathy

“…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].…”

“…The majority of children however have a benign course. A report by Gilbert and Wiggelinkhuizen [31]in 1994 in a study from Cape Town reported 71 children with HBV-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.…”

“…Almost all morphological forms of renal disease including MN, membranoproliferative glomerulonephritis, mesangial proliferative glomerulonephritis, minimal change disease, IgA nephropathy, focal segmental glomerulosclerosis, have been described [29, 30, 31, 32]. The major renal manifestations of HBV are summarized in table 2.…”

HBx transfection limits proliferative capacity of podocytes through cell cycle regulation

“…The relationship between chronic HBV infection and glomerulonephritis is confirmed, which draws an increasing attention due to widespread infection of HBV in Chinese children. Most patients with HBV-GN present with nephrotic syndrome, and some of them show refractory proteinuria and eventually progress to end-stage renal failure [2,3]. Membranous nephropathy is the predominant pathological type of HBV-GN in children.…”