Hepatitis B Virus Markers in Adult Patients with Glomerular Diseases

Ana Gonzalo, MD, Servicio de Nefrología, Hospital Ramón y Cajal, Crta. de Colmenar, Km 9, 100, E-28034 Madrid (Spain) Dear Sir, The association between hepatitis B virus (HBV) infection and glomerular disease was first reported in 1971 [1], and various morphological patterns including membranous, membranoproliferative and IgA glom-erulonephritides have been described with great geographical variations [2-4]. In order to appreciate the frequency of HBV-related nephropathy, we reviewed the HBV status of 137 adult patients with glomerular diseases, born and living in Spain at the time of diagnosis, studied during the years 1983-1994. Hepatitis C virus antibodies were negative in all patients by ELISA-2. There was a delay between apparent onset of nephropathy and hepatitis C virus test in some patients. HBV markers were investigated before kidney biopsy (table 1). HBsAg was detected in 4 of the 137 patients: in 3 of the 34 patients with membranous nephropathy and in 1 of the 30 patients with idiopathic nephrosis. The 4 patients exhibiting HBsAg were HlV-nega-tive men. Three of the 4 patients with HBS antigenemia (2 of them suffering from membranous nephropathy and 1 from idiopathic nephrosis) were healthy HBsAg carriers with normal liver function tests; they were anti-HBC and anti-HBe antibody positive and HBV DNA negative. The 4th patient, a 38-year-old man suffering from membranous nephropathy, presented with nephrotic syndrome. He had received blood transfusions at the age of 20 years. Serum HBeAg and anti-HBc were positive and HBV DNA and hepatitis D virus markers negative. The serum alanine aminotransferase values were increased, and a liver biopsy specimen showed chronic persistent hepatitis. In addition, 7 patients were anti-HBs/anti-HBc positive, and 1 was anti-HBc positive. None of these patients presented with a previous history of hepatitis or had increased levels of serum alanine aminotransferase. The prevalence of HBsAg carriers among apparently healthy volunteer blood donors was estiTable 1. HBV markers in patients with glomerular disease