Table of Contents

HK J Paediatr (New Series)
Vol 13. No. 1, 2008

HK J Paediatr (New Series) 2008;13:23-29

Review Article

Membranous Glomerulonephropathy Associated with Hepatitis B Virus Infection

XR Liu, Y Shen, YH Yang


The association between hepatitis B virus (HBV) infection and the development of nephropathy remains controversial. The chronic carrier state of Hepatitis B Virus leads to the development of glomerulonephropathy, the commonest histological type being membranous nephropathy (MN), particularly in children. Other types of glomerulonephritis associated with HBV infection are less common. Spontaneous clearance of HBV antigens, particularly the HBeAg, leads to resolution of proteinuria. The isolation of immune complexes in the kidney suggests that the pathogenesis of the disease may have an immune-complex basis. Genetic studies suggest a possible genetic predisposition to the development of HBV-MN. Cellular immune mechanism studies suggest HBV-MN children seem to have an inadequate cellular immune response to HBcAg. Membranous nephropathy in patients with chronic HBV carriage is the result of an interaction of virus and host factors. Although the natural history of the disease suggests a tendency to remission with supportive therapy, there is considerable morbidity. Anti-viral therapy (interferon or lamivudine) accelerates clearance of the virus and proteinuria. Immunisation with HBV vaccination is the most effective tool to reduce the incidence of HBV-MN.

乙型肝炎病毒感染與腎病發生之間的關係仍存在爭議。慢性乙型肝炎攜帶者所致腎小球腎病,最常見組織分型是膜性腎病,尤其在兒童患者當中更常見。其他類型的血管球性腎炎與乙型肝炎病毒感染相關的少見。自發地清除乙肝病毒抗原,尤其是 e 抗原(HBeAg),可清除蛋白尿。腎臟免疫複合物的分離提示疾病發生可能有免疫複合物基礎。遺傳學研究表明乙肝相關性膜性腎小球腎病可能存在遺傳易患病體質。細胞免疫機制研究提示乙肝相關性膜性腎小球腎病兒童患者,似乎有不合適的核心抗原(HBcAg )的免疫反應。慢性乙型肝炎攜帶者當中膜性腎病的發生是宿主因素與病毒相互作用的結果。雖然該病的自然病史提示支援療法有緩解趨勢,其仍有相當可觀的死亡率。抗病毒治療(干擾素或拉米夫定)增加了病毒及蛋白尿的清除率。乙肝病毒疫苗免疫是減少乙肝相關性膜性腎小球腎病發生率最有效的方法。

Keyword : Glomerulonephropathy; Hepatitis B Virus; Membranous



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