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Hepatitis B surface antigen in urine of hemodialysis patients
Insights
Hepatitis B surface antigen (HBsAg) is present in the urine of over 50% of chronic hemodialysis carriers. This finding suggests urine may transmit nonparenteral hepatitis B infections.
Area of Science:
- Hepatology
- Virology
- Epidemiology
Background:
- Chronic hemodialysis patients are a significant population for hepatitis B virus (HBV) surveillance.
- Hepatitis B surface antigen (HBsAg) carriers pose a risk for disease transmission.
Purpose of the Study:
- To investigate the presence of HBsAg in urine among chronic hemodialysis patients.
- To assess the potential role of urine as a vehicle for hepatitis B transmission.
Main Methods:
- Epidemiological survey of 701 chronic hemodialysis patients in Michigan.
- Radioimmunoassay and antibody neutralization to detect HBsAg in serum and urine samples.
- Analysis of urine samples from HBsAg carriers with urinary output.
Main Results:
- HBsAg was detected in the serum of 11% (79/701) of patients; 59 were chronic carriers.
- 52% (19/36) of HBsAg carriers with urinary output had detectable HBsAg in their urine.
- HBsAg was not found in the urine of non-carriers or carriers with normal renal function.
Conclusions:
- Patients on maintenance hemodialysis are a substantial reservoir of chronic HBsAg carriers.
- A significant proportion of urine-producing HBsAg carriers excrete the antigen in urine.
- Urine may be a potential transmission route for nonparenterally acquired hepatitis B.
Abstract:
As part of an extensive epidemiological survey of chronic hemodialysis patients in Michigan, hepatitis B surface antigen (HBsAg) was identified in the sera of 79 of 701 (11%) patients. Of these patients, 59 were carriers of HBsAg for three or more months. Urine samples were collected from 36 of 39 HBsAg carriers having urinary output. Of these samples, 19 (52%) were positive for HBsAg by radioimmunoassay; this was confirmed by specific antibody neutralization. The HBsAg was not identified in the urine of seven hemodialysis patients who were lacking serum HBsAg or in urine samples from three HBsAg sero-carriers who had normal renal function. Patients undergoing maintenance hemodialysis appear to constitute a large reservoir of HBsAg chronic carriers. This study indicates that a minimum of 50% of persistent HBsAg carriers who are producing urine have detectable HBsAg in single, randomly timed, unconcentrated urine specimen. These data suggest that urine may represent a potential vehicle for transmission in nonparenterally acquired hepatitis B.