Membranous nephropathy related to hepatitis B virus in adults

N Engl J Med. 1991 May 23;324(21):1457-63. doi: 10.1056/NEJM199105233242103.

Abstract

Background: The natural course of adult hepatitis B virus (HBV)-related membranous nephropathy in areas where HBV infection is endemic (characterized by vertical and horizontal transmission of HBV in early childhood) has not been fully defined.

Methods: We evaluated the clinical features, pathological findings, serologic profiles, therapeutic responses, and prognoses of 21 patients with adult-onset HBV-related membranous nephropathy. The patients were followed for a mean of 60 months (range, 12 to 108). Only patients with evidence of glomerular capillary deposition of hepatitis B e antigen (HBeAg) in a renal-biopsy specimen were included.

Results: The clinical features and serologic studies suggested that the patients had acquired chronic HBV infection in early childhood; moreover, other causes of membranous nephropathy had been excluded. All were seropositive for hepatitis B surface antigen and had high titers of antibody to hepatitis B core antigen at first clinical presentation. HBeAg was detected in the serum of 17 patients (81 percent), yet only 3 had even slightly increased plasma alanine aminotransferase levels. The clinical response to therapy with interferon alfa was disappointing; only one of the five patients treated had a complete remission with seroconversion to antibody to HBeAg. Contrary to reports of studies in children, spontaneous remission of the nephrotic syndrome or proteinuria was uncommon in the adults with HBV-related membranous nephropathy whom we studied. Proteinuria and HBV antigenemia persisted in untreated patients. During the follow-up period, 29 percent of the patients had progressive renal failure and 10 percent required maintenance dialysis therapy.

Conclusions: The course of HBV-related membranous nephropathy in adults in areas where HBV is endemic is not benign. Regardless of treatment, the disease has a slowly but relentlessly progressive clinical course in approximately one third of patients.

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease
  • Female
  • Glomerulonephritis, Membranous / etiology
  • Glomerulonephritis, Membranous / microbiology*
  • Glomerulonephritis, Membranous / therapy
  • Hepatitis B / complications
  • Hepatitis B / transmission
  • Hepatitis B Antibodies / analysis
  • Hepatitis B Surface Antigens / analysis
  • Hepatitis B e Antigens / analysis
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Interferon Type I / therapeutic use
  • Kidney / pathology
  • Male
  • Middle Aged

Substances

  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis B e Antigens
  • Interferon Type I