Clinical And Pathological Analysis Of HBV-associated Membranous Nephropathy

Background and objectiveHepatitis B virus(HBV)infection the most common chronic viral infection in the world,approximately 30% of the world's population have serological presentations of current and/or past infection.A survey conducted by the US Centers for Disease Control and Infection shows that Asia-Pacific region including China is one of the regions which have the highest rate of chronic HBV infection.Patients with HBV infection usually have clinical presentations of acute or chronic hepatitis.When organs other than the liver was affected,patients could show off-liver presentations,HBVassociated glomerulonephritis(HBV-GN)is a disease when kidney gets involved of HBV infection.HBV-GN is a glomerulonephritis mediated by immune complex,its specific pathogenesis remains unclear but it is likely related to immunoreaction and activation of complement system.HBV-associated membranous nephropathy(HBV-MN)is the most common seen histologic type and tended to increase.Patients with HBV-MN usually come to hospitality because of edema,with microhematuria and some of them presents as renal failure,but persistent massive load of proteinuria often leading to early renal failure.Therefore,early diagnosis and treatment could improve the survival rate and life quality of HBV-MN patients,showing great clinical significance.Actually,there is no specific diagnosis code of HBV-MN,the finding of HBV-MN patients with no serum HBV associated markers brings more challenge to the traditional diagnosis standards.In order to observe the clinical and pathological features of HBV-MN,providing new thoughts for the diagnosis of HBV-MN,we admitted 50 patients with HBV-MN and 56 patients with IMN combing HBV infection to analysis the difference clinical and pathological characteristics of both groups.Methods50 patients who were diagnosed with HBV-MN by renal biopsy and 56 patients with HBV infection who were diagnosed with IMN were selected.Patients from both groups were hospitalized in the first hospital of Zhengzhou university from Jan 2013 to Dec 2018 and all patients were clinically ruled out diabetes.Clinical,laboratory,and pathological data were collected and analyzed to compare the differences in renal and liver function,24-hour-urine total protein,serum albumin,C3,C4,total cholesterol as well as renal IgG1-4,C3,C4,C1 q and PLA2 R of both groups.Results1.Clinical features: patients in both groups were mainly male,young to middle aged,the average age of HBV-MN group was 37.2 ±14.187-year-old,it was younger compared with IMN group(P=0.003).Most common clinical presentation was nephritic syndrome.The differences in mean course,renal and liver function,24-hoururine total protein,serum albumin,C3,C4,total cholesterol,whether combining anemia,thrombocytopenia,hypertension,liver cirrhosis of both has no statistics significance(P >0.05).The level of serum C3 and C4 in HBV-MN group was lower compared with IMN group.(P=0.002,P=0.014).6 patients with HBV-MN have negative trace of serum HBV-markers,5 patients have positive presentations of pathological PLA2 R.2.Renal pathology features: HBV-MN group showed higher intensity in C1 q and IgG1,lower intensity in IgG4 compared with IMN group(P=0.001,P=0.003,P=0.025).The intensity of IgG1 was higher compared with the intensity of IgG2 and IgG3 in HBV-MN group(P=0.000,P=0.000),but had no statistic signigicance compared with IgG4(P=0.485).ConclusionRenal biopsy was essential to diagnose HBV-MN,lower level of serum C3 and C4,high intensity of renal C1 q and IgG1 provided new reference evidence for patients with both HBV-associated antigen and PLA2 R in the renal tissue,and HBV-MN shouldn't be ruled out just by negative serum HBV-associated markers.