Hepatitis B surface antigenemia in North American children with membranous glomerulonephropathy. Southwest Pediatric Nephrology Study Group
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Hepatitis B-associated membranous glomerulonephropathy (MGN) is more common in young North American boys than previously thought. This distinct kidney disease often presents with nephrotic syndrome and low C3 complement levels.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Immunology
Background:
- Membranous glomerulonephropathy (MGN) is a significant cause of nephrotic syndrome in children.
- Hepatitis B virus (HBV) infection has been implicated in MGN, but its prevalence in North American children is not well-established.
Purpose of the Study:
- To investigate the clinical characteristics and prevalence of hepatitis B-associated MGN in North American children.
- To determine if hepatitis B-associated MGN represents a distinct clinicopathologic entity in pediatric populations.
Main Methods:
- Retrospective case series of 11 North American children diagnosed with hepatitis B-associated MGN.
- Analysis of clinical data, laboratory results (including serum C3 levels and liver enzymes), liver biopsies, and renal biopsy findings (including immunofluorescence).
Main Results:
- Hepatitis B-associated MGN predominantly affected young (mean age 5.3 years) Black boys (7/11).
- Most patients (10/11) presented with nephrotic syndrome; elevated liver enzymes were common (8/10), despite minimal clinical liver disease.
- Renal biopsies showed characteristic glomerular changes, and immunofluorescence revealed multiple immunoreactants. Low serum C3 levels were observed in all patients.
Conclusions:
- Hepatitis B-associated MGN is likely underdiagnosed in North American children.
- The condition appears to be a distinct clinicopathologic entity characterized by specific demographic, clinical, and laboratory findings.
- Early identification and management are crucial, as one patient progressed to end-stage renal disease.
Abstract:
We describe 11 North American children with hepatitis B-associated membranous glomerulonephropathy (MGN). The children are predominantly black boys (seven of 11) and younger (mean age 5.3 years) than children with idiopathic MGN (10.6 years) or lupus-associated MGN (13.4 years). Most of the patients (10 of 11) had nephrotic syndrome, and although clinical evidence of liver disease was present in only one child, eight of 10 patients had elevated aspartate amino transferase levels. Liver biopsies performed in three children revealed chronic persistent hepatitis in two and chronic active hepatitis in one. Hepatitis B surface antigen was found in the serum of one of the parents of five patients and in the brother of one patient. Low serum C3 values were observed in all 11 children at some stage of their illness. Renal biopsy specimens revealed stage II or III glomerular capillary wall changes, and immunofluorescence studies revealed three or more glomerular immunoreactants in 10 of 11 biopsies. One patient developed end-stage renal disease 9 years after presentation of nephrotic syndrome; the duration of follow-up of the other 10 patients is limited at this time. We conclude from these data that hepatitis B-associated MGN is more frequent in North American children than previous reports have suggested, is most commonly seen in young black boys, and is characterized by low serum C3 levels. It appears, therefore, to be a distinct clinicopathologic entity.