The relationship between HBV serum markers and the clinicopathological characteristics of hepatitis B virus-associated glomerulonephritis (HBV-GN) in the northeastern chinese population

Abstract

BackgroundTo investigate the effect of HBV markers on HBV-GN.MethodsThe immunohistochemistry was used to detect HBsAg and HBcAg in frozen sections of renal biopsy, the changes in HBV serum markers, renal functional parameters and clinical manifestations or symptoms were observed to analyze renal damage.ResultsUsing renal biopsy data from 329 cases, this study found that the most common pathological subtype in HBV-GN was mesangioproliferative glomerulonephritis (MsPGN) (24.9%, P <0.05), and 29.4% of patients who show serological HBsAg, HBeAg and anti-HBc positive developed membranoproliferative glomerulonephritis (MPGN) (P <0.05). The immunohistochemistry was used to detect HBsAg and HBcAg in frozen sections.50% of HBsAg and HBcAg deposits was observed in the glomeruli of MPGN patients, while 36.6% of HBsAg and 43.9% of HBcAg deposited in the glomeruli of MsPGN patients. The deposits of HBsAg and HBcAg in glomeruli were directly correlated with IgA, IgG, IgM and C3 deposits. In addition, cases with a moderate to severe decrease as reflected by the glomerular filtration rate (GFR) were predominantly patients with MPGN (31.6%, P <0.05) or MsPGN (21.1%, P <0.05). Patients who were serological HBsAg, HBeAg and anti-HBc positive or HBsAg, anti-HBe and anti-HBc positive mainly exhibited urine and renal parameter changes.ConclusionExamination of HBV markers in serum and renal biopsy will be useful for clinicians to predict the renal damage in early stage when it is reversible in HBV-GN.

Hepatitis B Virus-related Vasculitic Neuropathy in an Inactive Virus Carrier Treated with Intravenous Immunoglobulin

“…This might be due to poor sensitivity of these staining techniques or to an actual lack of HBsAg deposition. In fact, a discrepant deposition pattern has been reported between HBsAg and HBcAg in the glomeruli of patients with HBV-related renal disease ( 12 ). Although existing studies have not applied HBcAg staining to HBV-related neuropathy, the presence of this HBV-related antigen in vascular endothelial cells and around the nerve vessels in our case seems to be strong evidence for the role of HBV in neuropathy.…”

Successful entecavir plus prednisolone treatment for hepatitis B virus-associated membranoproliferative glomerulonephritis

“…Among these, HBV-MPGN in adults has been reported to have a poor prognosis, with mortality or development of end-stage kidney disease, [5,8] while HBV-MN in children has been reported to show spontaneous remission and a good renal prognosis. [4,5,16,17] Zhang et al [8] reported that HBV-MPGN was at its highest prevalence in patients with elevated serum creatinine levels and argued that marked renal impairment was associated with MPGN. We believe that patients should be treated according to their disease and clinical characteristics such as histological type, magnitude of proteinuria, and age.…”

“…[5][6][7] However, studies on antiviral monotherapy for HBV-GN were predominantly comprised of cohorts of patients with hepatitis B virus-associated membranous nephropathy (HBV-MN); therefore, the efficacy of antiviral monotherapy for HBV-MPGN remains unknown. Furthermore, though the quantity of serum HBV-related antigens exacerbate HBV-GN by increasing the deposition of HBV-related antigens, IgA, IgG, IgM, and complement in the glomeruli, [8] the current treatment modalities for HBV infection hardly eliminate HBsAg. Although the current treatment target of hepatitis B infection is a "functional cure," defined as sustained absence of HBsAg, [9,10] it proceeds at very low rates when treated with entecavir (3% at 96 weeks).…”

“…HBV infection is associated with various morphologic histopathological types of glomerular lesions, [8,14] including HBV-MN, [5,15] HBV-MPGN, mesangial proliferative nephritis, and focal glomerulosclerosis. Among these, HBV-MPGN in adults has been reported to have a poor prognosis, with mortality or development of end-stage kidney disease, [5,8] while HBV-MN in children has been reported to show spontaneous remission and a good renal prognosis. [4,5,16,17] Zhang et al [8] reported that HBV-MPGN was at its highest prevalence in patients with elevated serum creatinine levels and argued that marked renal impairment was associated with MPGN.…”

“…Quan et al [18] advocated the influence of serum HBsAg titers in HBV-GN, and our patient's serum HBsAg levels were high (16,485 IU/mL). Furthermore, Zhang et al, [8] who examined the relationship between serum HBV infectious markers and the staging of renal function in HBV-GN, reported that patients positive for HBsAg, HBeAb, and HBcAb had the highest prevalence of chronic kidney disease stage V (80%). Our patient had just the same pattern of serum HBV markers.…”