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Hepatitis B 's' and 'e' antigen carriage in childhood nephrotic syndrome predicts membranous glomerulonephritis
H M Coovadia1, M Adhikari, D Moodley
1Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa.
Insights
Hepatitis B infection significantly increases the risk of membranous nephropathy in African children with nephrotic syndrome. Serological tests for hepatitis B surface antigen (HBsAg) and hepatitis B
Area of Science:
- Pediatric Nephrology
- Hepatology
- Infectious Diseases
Background:
- Nephrotic syndrome in African children presents unique etiological challenges.
- Hepatitis B virus (HBV) infection is a known cause of kidney disease globally.
- The specific association between HBV and membranous nephropathy (MN) in this population requires further elucidation.
Purpose of the Study:
- To investigate the prevalence of hepatitis B infection markers in African children with nephrotic syndrome.
- To determine the association between hepatitis B surface antigen (HBsAg) and hepatitis B 'e' antigen (HBeAg) positivity and membranous nephropathy.
- To assess the diagnostic utility of HBsAg and HBeAg serology for predicting MN, potentially avoiding renal biopsy.
Main Methods:
- Retrospective analysis of 178 African children diagnosed with nephrotic syndrome.
- Histological classification of kidney lesions, including membranous nephropathy.
- Serological testing for hepatitis B surface antigen (HBsAg) and hepatitis B 'e' antigen (HBeAg).
Main Results:
- Membranous nephropathy was the most common histological lesion (34%), predominantly associated with HBV.
- HBsAg positivity was found in 95% and HBeAg in 86% of children with MN, versus only 5% and 0.8% in non-MN cases.
- HBsAg and HBeAg showed high sensitivity (>87%) and specificity (>90%) for predicting MN, with significantly elevated risk ratios (35x for HBsAg, 15x for HBeAg).
Conclusions:
- Hepatitis B virus infection is strongly associated with membranous nephropathy in African children with nephrotic syndrome.
- Serological detection of HBsAg and HBeAg can reliably predict membranous nephropathy in this cohort.
- HBsAg and HBeAg testing may obviate the need for renal biopsy in diagnosing MN in HBV-infected children with nephrotic syndrome.
Abstract:
Among 178 African children with nephrotic syndrome, membranous nephropathy was the commonest histological lesion (60 children; 34%). Fifty-seven (95%) of these 60 were hepatitis B surface antigen (HBsAg)-positive, and 52 (86%) of these 57 were hepatitis B 'e' antigen (HBeAg)-positive. HBsAg was detected in only six (5%) and HBeAg in one (0.8%) of the 118 patients with non-membranous lesions. The risk of membranous nephropathy was 35 and 15 times higher in the 178 African children with nephrotic syndrome who had serological evidence of HBsAg and HBeAg, respectively, than in those who did not. Sensitivity was 95% for HBsAg and 87% for HBeAg; specificity, and positive and negative predictive values were above 90% for each antigen. The strength of such an association in this particular community permits reliable prediction of membranous nephropathy from serological tests for HBsAg and HBeAg, thereby avoiding renal biopsy.