Effect of Hepatitis B Virus Infection of Membranous Nephropathy

Abstract

To elucidate the effect of HBsAg on MN, 107 cases of MN admitted to SNUH from 1979 Jan. to 1985 Dec. were evaluated according to the markers of HBV. Positive rate of HBsAg in MN was 48% which was higher than normal population and primary GN. Males were affected 4 times greater than females. MN with HBs antigenemia differed from MN without the antigen by having a lower incidence of nephrotic syndrome and azotemia. Serologically, positive rate of rheumatoid factor, ANA and rate of C4 decrement was higher in HBsAg positive patients, indicating the active participation of immune responses. Light microscopy demonstrated MPGN III -like lesions showing subendothelial deposit and double contour with mesangial hypercellularity, segmental change, tubular atrophy and interstitial fibrosis. Immunofluorescent microscopy showed frequent deposits of IgA and IgM in HBsAg positive group, and HBsAg, HBcAg were demonstrated in 76.9% and 31.4% of them. Although the exact pathogenesis is not clear, the participation of multiple antigen and antibody system including HBsAg and HBcAg was clear, as well as the participation of hepatic dysfunction caused by liver cirrhosis on immune complex of rheumatoid factor, IgA deposit, subendothelial deposit have been proved to meet a concerted effect in the characterization of HBsAg related MN showing lupus-like features.