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Membranous nephropathy associated with hepatitis B in Spanish children
A Peña1, M J Débora, M Melgosa
1Department of Paediatric Nephrology, Hospital Infantil La Paz, Madrid, Spain. apena@hulp.es
Insights
Pediatric membranous nephropathy (MN) linked to hepatitis B (HB) shows excellent long-term outcomes in children, with spontaneous resolution of kidney issues. Most patients remained hepatitis B surface antigen (HBsAg) positive post-recovery.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Virology
Background:
- Membranous nephropathy (MN) is a rare kidney disease in children.
- Hepatitis B (HB) infection is a known, though uncommon, cause of MN.
- Understanding the long-term evolution of HB-associated pediatric MN is crucial for management.
Purpose of the Study:
- To retrospectively analyze the long-term outcomes and treatment responses of pediatric patients with membranous nephropathy associated with hepatitis B.
- To investigate the clinical presentation and evolution of renal function in this specific patient cohort.
Main Methods:
- Retrospective review of clinical records of 12 children diagnosed with HB-associated MN between 1970 and 1996.
- Analysis of proteinuria, hematuria, serological markers (HBsAg, HBeAg), renal function, and liver histology.
- Family studies were conducted to assess hepatitis B transmission.
Main Results:
- All 12 patients tested positive for hepatitis B surface antigen (HBsAg); 6 were also positive for hepatitis Be antigen (HBeAg).
- Proteinuria was universal, with 8 patients presenting in the nephrotic range. Steroid treatment in 7 nephrotic patients showed resistance.
- After a mean follow-up of 9.95 years, all patients achieved normal renal function with resolution of proteinuria and hematuria. Seven out of eight studied families had positive hepatitis B markers.
Conclusions:
- Pediatric membranous nephropathy associated with hepatitis B is rare but has an excellent long-term prognosis, irrespective of treatment.
- All patients remained HBsAg positive long-term, indicating persistent viral infection.
- Hepatitis B is a significant cause of pediatric MN in the studied region, often with familial transmission.
Aim:
To examine retrospectively long-term evolution and treatment of pediatric membranous nephropathy (MN) cases associated with hepatitis B (HB) in the hospital "La Paz".
Material And Methods:
The clinical records of 12 children diagnosed with HB-associated MN in our hospital between 1970 and 1996.
Results:
All patients were positive for hepatitis B surface antigen (HBsAg); 6 were tested for hepatitis Be antigen (HBeAg) and were also positive. At onset, all of them had proteinuria (8 in nephrotic range), 6 had microscopic hematuria and 4 macroscopic hematuria. Seven of 8 children who started with a nephrotic syndrome received steroids and all of them were steroid-resistant. After 9.95 +/- 5.88 years of follow-up, renal function remained normal and proteinuria and hematuria have disappeared in all of them. A family study for hepatitis B was carried out in 8 cases and 7 of them were positive. Only in one case vertical transmission was demonstrated; this patient remained HBeAg positive. In 7 patients, hepatic biopsy was performed: 3 had a chronic active hepatitis, 3 a persistent chronic hepatitis and one a residual acute hepatitis.
Conclusions:
Membranous nephropathy is a rare pediatric disease in our area and most of the cases are related to hepatitis B (HB). The outcome was excellent with and without treatment but all of them remained HBsAg positive.