Association Between Hepatitis B Virus Infection And Renal Disease

A Strong Link between HBV Infection and Renal Disease

Hepatitis B Virus
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Around 350 million to 400 million individuals all over the world are suffering from Hepatitis B infection. In the U.S., approximately 1.25 million infected people have been estimated. In those regions where the disease is endemic, the transmission of the virus has been discovered as of vertical type or from mother to baby, in simpler terms. In other parts of the world, the transmission occurs through blood products, direct contact with inner body layers and sharing of needles or other equipment.

Studies have revealed that glomerulonephritis is a kind of hypersensitivity reaction by the body in response to the HBV infection.


The strong link between HBV infection and glomerulonephritis was first described by Coombs and his coworkers in the year 1971. Since then, this topic has received much attention by scientists and medical research professionals.


HBV infection can affect the proper functioning of kidneys at any age. It has been found that the involvement of kidneys is more in children. In children, the main two findings are nephrotic syndrome and microscopic hematuria (blood in urine).

In adults, apart from nephrotic syndrome, the findings are as follows:

  • Increased blood pressure
  • Hyperproteinuria (too many proteins in urine)
  • Improper kidney functioning
  • Liver dysfunction

The main kidney problem that is associated with HBV infection is glomerulonephritis. The glomeruli are from an important part of your kidneys and are composed of fine blood vessels.

These groups of blood vessels help in the process of blood filtration and squeeze out the excess of fluid. Damage to glomeruli can lead to dysfunction of your kidneys and that may finally cause kidney failure. Glomerulonephritis (GN) is the collective term used to define the conditions that injure the glomeruli.

If a person has HBV, glomerulonephritis is confirmed by the detection of presence of virus in the blood and presence of HBV antigens in glomeruli. Most of the patients show a positive test for HBeAG (hepatitis B “e” antigen).

There are three forms glomerulonephritis associated with HBV namely:

  1. Membranous nephropathy: It is the most common form. Rarely does it affect children without HBV infection or those who are suffering from SLE (systemic lupus erythematosus). It has been observed that in the adult population of white Americans, this form is the most common pattern of idiopathic nephrotic syndrome.
  2. Membranoproliferative glomerulonephritis: This form is also quite common. Under a microscope when the glomeruli are observed, some appear to have a normal structure with a thin basement membrane. On the other hand, there are other glomeruli that have a split in their basement membranes. They exhibit a “tram track” pattern.
  3. Immunoglobulin A nephropathy: This form is seen mostly in children and in people from Asia.


    In children, the prognosis is considered good but they experience the highest rate of spontaneous remission (spontaneous cure or healing) if the kidney functioning is in a stable condition.

    In adults, the results are vastly different. The disease shows to progress and develop outcomes like renal (kidney) failure in about 29% of the cases and end-stage renal disease in almost 10% of cases. The prognosis has shown worsening in individuals who have nephrotic syndrome or show abnormal values during liver function tests.

    Treatment for HBV

    The permanent, surefire treatment for HBV glomerulonephritis is uncertain.

    Corticosteroids: These are feared to worsen the situation more than rendering any benefit. This is because they can enhance the replication process of HBV.

    Pegylated interferon: This drug has proved to be quite effective in case of children who show improvement even without prior treatment. In case of adults, the mixed results have been observed.

    Lamivudine: Only a small percentage of success has been achieved by treating patients with this drug. One of the biggest problems with treatment with lamivudine is that the person develops resistance to this drug. This can be avoided to some extent by stopping the use of the drug once the disease gets stabilized. This happens quite rarely. The combination of lamivudine is being tried with interferon alpha.

    Research is still going on to discover or invent a sure-shot medicine for glomerulonephritis caused due to HBV infection.


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