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Journal of the Korean Society of Pediatric Nephrology 1998;2(1): 50-59.
B형 간염 바이러스 감염과 연관된 사구체신염의 임상병리학적 특성과 신 조직내에서 HBs Ag 과 HBe Ag의 발현
정수진, 김영주, 윤혜경, 정우영, 김영훈, 김수영
1인제대학교 의과대학 부산백병원 병리학교실
2인제대학교 의과대학 부산백병원 병리학교실
3인제대학교 의과대학 부산백병원 병리학교실
4인제대학교 의과대학 부산백병원 소아과학교실
5인제대학교 의과대학 부산백병원 내과학교실
6부산대학교 의과대학 소아과학교실
Clinicopathologic Features and HBsAg and HBeAg Expressions in Hepatitis B Virus-associated Glomerulopathy
Soo-Jin Jung, Young-Joo Kim, Hye-Kyoung Yoon, Woo-Yeong Chung, Young-Hoon Kim, Su-Yung Kim
1Department of Pathology, Inje University, College of Medicine, Pusan Paik Hospital
2Department of Pathology, Inje University, College of Medicine, Pusan Paik Hospital
3Department of Pathology, Inje University, College of Medicine, Pusan Paik Hospital
4Department of Pediatrics, Inje University, College of Medicine, Pusan Paik Hospital
5Department of Internal medicine, Inje University, College of Medicine, Pusan Paik Hospital
6Department of Pediatrics, Pusan University, College of Medicine
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Purpose : Hepatitis B virus (HBV) infection has been involved in several forms of immune-related glomerulopathy but the pathogenic role of HBV infection is not clear. To evaluate the clinicopathological features of HBV-associated glomerulopathy, a clinicopathological analysis and immunohistochemical stain for HBs Ag and HBe Ag were done.
Methods : Clinicopathological features of HBV-associated glomerulopathy were analyzed with renal biopsies in 28 HBsAg seropositive patients from April 1990 to February 1997 at Pusan Paik Hospital, and immunohistochemical evaluation for HBsAg and HBeAg was done in renal tissues. Light microscopic, immunofluorescent and electron microscopic examination and immunohistochemical staining for HBsAg (DAKO) and HBeAg (BIONIKE) of renal tissue were performed. Result ; 1. The age distribution was 6 to 73 years old, and eight were children and 20 were adults. Male : female ratio was 3:1. Nineteen (67.9%) and 21 (75.0%) of 28 cases showed hematuria and proteinuria, respectively at the time of biopsy. Sixteen (57.2%) of them had nephrotic syndrome. 2. Liver function test was performed in 11 patients and seven (63.6%) of them showed increased AST and ALT levels. Liver biopsy was done in three patients and revealed findings of chronic active hepatitis. 3. HBV-associated glomerulopathy was membranous glomerulonephritis (MGN) in 10 (35.7%), mesangiopathy in 8 (28.6%), membranoproliferative glomerulonephritis (MPGN) in 7 (25.0%) and minimal change disease in 3 (10.7%) out of 28 cases. 4. Ultrastructurally HBV-associated MGN showed conspicuous subepithelial deposits with intramembranous, mesangial and subendothelial deposits and proliferation of mesangial cells and matrix, which were suggestive of MPGN. In HBV-associated MPGN, intramembranous and subepithelial deposits were scattered. 5. Immunohistochemical staining revealed no expression for HBsAg, but positive reaction for HBeAg along capillary wall in 8 cases (28.6%), of which 3 cases were checked for serum HBeAg, all showed positivity.
Conclusion : HBV-associated glomerulopathy showed a wide morphologic spectrum and overlapping ultrastructural features in MGN and MPGN, and the activity of hepatitis B virus may be related to the development of HBV-associated glomerulopathy but further studies are recommended to confirm this relationship.
Key words: Hepatitis B Virus-associated Glomerulopathy | Clinicopathological features | HBs Ag | HBe Ag | Renal biopsy
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