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Worldwide perspective of hepatitis B-associated glomerulonephritis in the 80s
Abstract:
Chronic HBsAg carriers may develop glomerulonephritis (GN). Besides membranous GN (MGN), which seems a well established association, membranoproliferative GN (MPGN) or proliferative GN are also encountered in these patients. It is clear that the variations in the incidence of hepatitis B virus (HBV) GN may be real or related to a more or less vigorous search for HBV in the different nephrologic centers. However, the frequency of HBV GN in a country correlates with the underlying prevalence of HBV infection in the general population. Geographic patterns of HBV prevalence vary greatly from areas of low endemicity where less than 1% of adults are chronic carriers to areas of intermediate and high endemicity where between 2 and 15% of adults are chronic carriers. The most important factor affecting prevalence is age of HBV infection. The probability of becoming a chronic carrier is greater following infection during infancy and early childhood. The rarity of HBV GN in the U.S. and in western Europe probably reflects the rarity of HBV infection, especially in children. The frequency of HBV GN is high in Asian or Black children. It is possible to hope that, with the extensive immunization in countries of high endemicity, the frequency of HBV GN will diminish. In the U.S. and in Europe, patients with HBV GN frequently belong to high risk groups for HBV infection. In these countries, the increase in the percentage of HBV infection due to sexual transmission or linked with drug abuse may lead to an increase in the percentage of adult patients with HBV GN.
Insights
Chronic hepatitis B surface antigen (HBsAg) carriers can develop glomerulonephritis (GN). HBV GN frequency correlates with HBV prevalence, with higher rates in endemic areas and younger infections.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Chronic hepatitis B surface antigen (HBsAg) carriers are at risk for developing glomerulonephritis (GN).
- Hepatitis B virus (HBV)-associated GN encompasses various forms, including membranous GN (MGN), membranoproliferative GN (MPGN), and proliferative GN.
- The incidence of HBV GN is influenced by HBV prevalence and diagnostic practices in nephrology centers.
Purpose of the Study:
- To explore the association between chronic hepatitis B virus infection and glomerulonephritis.
- To analyze the geographical and demographic factors influencing the prevalence of HBV-associated GN.
- To discuss the potential impact of HBV vaccination on the future incidence of HBV GN.
Main Methods:
- Literature review and analysis of epidemiological data on HBV infection and GN.
- Correlation of HBV prevalence rates with reported cases of HBV GN across different regions.
- Examination of age at infection and transmission routes as factors in chronic HBV carrier status and GN development.
Main Results:
- HBV GN frequency strongly correlates with the prevalence of HBV infection in the general population.
- Higher rates of HBV GN are observed in areas of intermediate to high HBV endemicity, particularly in Asian and Black children.
- In low-prevalence regions like the U.S. and Western Europe, HBV GN patients often belong to high-risk groups, with increasing adult cases linked to sexual transmission and drug abuse.
Conclusions:
- The prevalence of HBV GN is directly linked to the endemicity of HBV infection, with age at infection being a critical factor.
- Widespread HBV immunization is expected to reduce the incidence of HBV GN in endemic countries.
- In non-endemic regions, understanding transmission routes like sexual contact and drug use is crucial for managing HBV GN in at-risk adult populations.