bubble_chart Overview

Hepatitis B virus-associated nephritis refers to kidney injury caused by the hepatitis B virus through immune mechanisms or the virus itself. It is one of the common secondary nephritis conditions in children.

bubble_chart Clinical Manifestations

The onset is insidious, with about half of the children showing no obvious subjective symptoms. Renal involvement may manifest as asymptomatic proteinuria, hematuria, or nephrotic syndrome. There may be varying degrees of edema, and hypertension is generally not prominent. These manifestations can change during the course of the disease, which is typically prolonged. Half of the affected children have hepatomegaly, and a few may exhibit abnormal liver function.

bubble_chart Auxiliary Examination

1. Detection of serum HBV infection markers: Blood HBsAg, HBeAg, HBcAg positive, half of the children are HBV-DNA positive. As the condition recovers, antibodies appear.
2. Liver function: Some children have elevated transaminase levels.
3. Urine tests show varying degrees of proteinuria and hematuria.
4. Others: In the initial stage [first stage] of the disease, blood complement C3 may decrease.
5. Renal pathology: Mainly membranous or membranoproliferative changes. In addition to basement membrane changes, mesangial proliferation is often present. Immunofluorescence tests may show deposits of IgA, IgG, and C3. HBV antigens can be detected using immunofluorescence or enzyme labeling techniques. Under electron microscopy, electron-dense deposits can be seen not only on the epithelial side of the basement membrane but also in the subendothelial and mesangial areas.

bubble_chart Diagnosis

1. Serum HBV antigen positive.
2. Suffering from glomerulonephritis or nephropathy, and secondary glomerular diseases such as lupus nephritis can be excluded.
3. HBV antigen is found in renal tissue sections.

Since membranous nephropathy is rare in children, and hepatitis B virus-associated nephritis often presents with membranous changes, in pediatric patients showing membranous changes, positive serum HBV antigen, and exclusion of lupus nephritis, a clinical diagnosis of hepatitis B virus-associated nephritis can be made even if HBV antigen is not found in renal tissue.

bubble_chart Treatment Measures

1. General treatment: Pay attention to appropriate rest and supplement vitamins in the diet. Provide general liver-protective therapy.
2. There are still differing opinions on whether to use adrenal corticosteroids and immunosuppressants. Some advocate that for those presenting with clinical nephrotic syndrome, prednisone 1–1.5 mg/(kg·d) may be tried based on the condition, gradually reducing after 8 weeks, with a total course of about half a year. Others argue that such drugs inhibit antibody production, prolong the disease course, and are detrimental to the condition, and therefore should not be used.
3. Antiviral treatment: Methods vary. Some recommend using prednisone for 3 months first, followed by α-interferon injections. In addition to inducing remission of nephropathy, this may also lead to the disappearance of HBV serum markers in some children.