At the 2024 American Association for the Study of Liver Diseases (AASLD) Annual Meeting, two significant studies by Dr. Yanyan Yu and Dr. Jinghang Xu from Peking University First Hospital garnered widespread attention. The first study revealed that 73.7% of patients with hepatitis B virus-associated glomerulonephritis (HBV-GN) were HBsAg-negative, highlighting the importance of considering HBV-GN even in HBsAg-negative individuals presenting with renal damage. The second study identified serum total cholesterol (TCHO) as an independent predictor of end-stage renal disease (ESRD) in HBV-GN patients, offering new insights into prognosis evaluation. These findings enhance our understanding of HBV-GN and provide innovative approaches for its diagnosis, treatment, and prognosis assessment.
Study 1: High Proportion of HBsAg-Negative Patients in HBV-GN: A Retrospective Cohort Study
HBV-GN, a prevalent secondary glomerular disease in China, has traditionally been associated with positive HBsAg. However, recent reports have identified cases of HBsAg-negative HBV-GN. This retrospective cohort study compared the clinical and pathological characteristics of HBsAg-negative and HBsAg-positive HBV-GN patients, as well as their risk of developing end-stage renal disease (ESRD).
The study included 175 patients diagnosed with HBV-GN via renal biopsy at Peking University First Hospital between 2010 and 2020. Participants were grouped based on their serum HBsAg status. The majority of patients (74.9%) presented with nephrotic syndrome, and 97.1% had membranous nephropathy. Most patients had normal liver function (92.6%) and baseline renal function (85.7% in CKD stages 1-2).
Interestingly, 73.7% of patients were HBsAg-negative, while 26.3% were HBsAg-positive. HBeAg positivity was noted in 13.1% of patients, and HBV DNA was detected in 14.3%. When comparing the two groups, HBsAg-positive patients had significantly higher levels of ALT, AST, IgG, and IgA, but lower complement C3 levels. Baseline renal function did not differ significantly between groups.
HBsAg-positive patients received more antiviral therapy (78.3% vs. 6.2%, P < 0.001) but less corticosteroid therapy (21.7% vs. 48.1%, P = 0.002). Over a median follow-up of 120 months, 12.0% of patients progressed to ESRD, with no significant difference in risk between HBsAg-negative and HBsAg-positive groups (P > 0.05).
In conclusion, HBV-GN predominantly affects males and often presents as nephrotic syndrome with membranous nephropathy. A significant proportion of patients (73.7%) are HBsAg-negative, highlighting the importance of considering HBV-GN in HBsAg-negative patients with renal damage. HBsAg status does not influence the risk of developing ESRD. Clinicians should remain vigilant in diagnosing and intervening early in cases of HBV-GN, regardless of HBsAg status.
Study 2: Serum Total Cholesterol as an Independent Predictor of ESRD in HBV-GN: A Retrospective Cohort Study
HBV-GN, a common secondary glomerular disease in China, has limited long-term prognostic studies. This research compared clinical and pathological characteristics of HBsAg-negative and HBsAg-positive HBV-GN patients and identified ESRD predictors.
In a cohort of 175 patients followed for a median of 120 months, 12.0% progressed to ESRD. Lower baseline eGFR and higher TCHO independently predicted ESRD, while HBsAg or HBeAg status was unrelated to risk. Dose-response analyses revealed linear relationships for eGFR and TCHO with ESRD risk, but a non-linear relationship for age. Below 61 years, younger age was protective, while at or above 61 years, older age increased ESRD risk.
In conclusion, HBV-GN has a poor prognosis, with lower eGFR and elevated TCHO as independent predictors of ESRD. Age influences ESRD risk non-linearly. These findings aid in risk stratification and management of HBV-GN.
