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Hepatitis-B virus associated nephropathies: a clinicopathological study in 14 children
Sukru O Ozdamar1, Safak Gucer, Keriman Tinaztepe
1Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey. sozdamar@hacettepe.edu.tr
Insights
Hepatitis B virus (HBV)-associated glomerulonephritis is common in children, with membranoproliferative glomerulonephritis (MPGN) frequently observed alongside membranous glomerulonephritis (MGN). Prognosis for these kidney diseases in children is generally favorable, even without specific treatment.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Immunopathology
Background:
- Hepatitis B virus (HBV)-associated glomerulonephritides are increasingly reported, particularly in pediatric populations.
- The association between HBV and glomerulopathy is striking, necessitating further investigation into clinical and immunohistological features.
Purpose of the Study:
- To investigate the clinical and immunohistological characteristics of HBV-associated glomerulonephritis in children.
- To determine the prevalence of different glomerulonephritis types and the role of HBsAg in the pediatric population.
Main Methods:
- Clinical data and renal tissue samples from 14 children (2.5-16 years) with HBV-associated glomerulonephritis were analyzed.
- Light microscopy, immunofluorescence, and immunoperoxidase staining for HBsAg were performed on renal tissues.
- Liver tissue samples were examined in available cases.
Main Results:
- Nephrotic syndrome occurred in 64%, nephritic syndrome in 57%, and renal insufficiency in 28% of patients.
- Membranous glomerulonephritis (MGN) was diagnosed in 6, membranoproliferative glomerulonephritis (MPGN) in 7, and IgA nephropathy (IgAN) in 1 child.
- HBsAg was detected in glomeruli in 4 cases; chronic hepatitis was present in all 4 available liver samples.
Conclusions:
- HBV-associated glomerulonephritis in children can present as MPGN or MGN, often without overt hepatitis.
- The prognosis for these glomerulonephritides in childhood is generally favorable, with a 71% favorable outcome observed.
- This study reinforces the causal link between HBV infection and glomerulonephritis in pediatric patients.
Abstract:
Hepatitis B virus (HBV)-associated glomerulonephritides have been increasingly reported, and the association between HBV and glomerulopathy is striking, especially in children. In this study, we investigated clinical and immunohistological features of HBV-associated glomerulonephritis in 14 children aged from 2.5 to 16 years (mean 10 years). The nephrotic syndrome was present in 9 (64%) and the nephritic syndrome in 8 children (57%). Five children had both nephrotic and nephritic syndrome together (35%). Renal insufficiency was determined in 4 of 14 patients (28%). Surface antigen (HBsAg) was present in all, with no history of clinically apparent hepatitis. Investigation of all renal tissue samples with light and immunofluorescence microscopy confirmed the diagnosis of membranous glomerulonephritis (MGN) in 6, membranoproliferative glomerulonephritis (MPGN) in 7, and IgA nephropathy (IgAN) in 1 child. Renal tissue samples were studied by the immunoperoxidase method for HBsAg in all cases; only in 4 children was HBsAg detected in the glomeruli. Examination of liver tissue samples was available in 4 cases, revealing chronic hepatitis in all, with additional development of cirrhosis in 1 and the presence of HBsAg in hepatocytes in all. Of the patients, 8 received corticosteroid treatment; 1 of them achieved a complete remission, while 4 had a partial remission with persistent proteinuria and hematuria. Four patients who received no treatment had a spontaneous remission within 5 months to 10 years following the onset of the renal disease. Two patients died of renal failure, while 1 died of intercurrent sepsis. The patient with IgAN received interferon-alpha 2a and lamuvidine, which resulted in a remission and a marked decrease in HBV DNA titer. The remaining 2 were lost to follow-up. Although MGN has been reported as the nephropathy most commonly associated with HBsAg antigenemia in adults, our study revealed that MPGN could occur in children as well as MGN, without any clinical or historical evidence of hepatitis. The present study provides further evidence for a causal relationship between HBV hepatitis and HBs antigenemia-related glomerulonephritides in the pediatric age group. It also indicates the prognosis (71%) of the associated nephropathies with or without treatment is quite favorable in childhood.