Clinical and pathological analysis of hepatitis B virus-related membranous nephropathy and idiopathic membranous nephropathy

摘要

Objective: The Hepatitis B virus infection rate is high in the Chinese population. The implications of HBV infection are widely recognized, and membranous glomerulonephritis is the most common renal lesion associated with HBV infection. We compared the clinicopathologic features of 119 HBV-related membranous nephropathy (HBV-MN) and 143 idiopathic membranous nephropathy (IMN) patients to identify those factors that facilitate their discrimination. Methods: Cohort analysis of demographic information, clinical manifestations, laboratory parameters, renal pathology and prognostic features of the two groups. Results: Most HBV-MN patients were young or middle-aged; the onset age in the HBVMN group was younger than the IMN group (p < 0.05). A male predominance was found in both groups. And the two groups both presented with heavy proteinuria or nephrotic syndrome. In contrast to IMN patients, the HBV-MN group was presented with a high occurrence of microscopic hematuria (73.95 vs. 35.66%) and renal insufficiency (47.06 vs. 24.48%). Plasma complement C3 and C4 in HBV-MN patients were significantly lower than in IMN patients (p < 0.05). The hyperlipidemia was more severe in IMN patients (p < 0.05). The occurrences of segmental glomerular damage, mesangial cell proliferation and tubulointerstitial damage were more common in the HBV-MN group (p < 0.05). Immunofluorescence staining of polyclonal immunoglobulin and polytypic complement immunoglobulin were more frequent in the HBV-MN group. The followup data showed there were no statistic differences in the prognosis between HBV-MN and IMN. Conclusion: HBV-MN patients commonly showed nephrotic syndrome accompanied with renal and hepatic dysfunction which was different from IMN patients. The primary pathological feature of HBVMN was atypical membranous nephropathy, which is usually associated with the inflammatory changes in HBV infection. The renal survival rates did not differ between HBVMN patients and IMN patients.