Clinical Characteristics and Treatment of Patients with IgA Nephropathy and Hepatitis B Surface Antigen

Figures & data

Figure 1.  Comparison of histology based on WHO classification between idiopathic IgAN and HBV-IgAN. There was no difference in histology between two the groups.

Figure 2.  Immunohistochemical staining for HBsAg. Nine tissues were not stained by HBsAg as like A, one case (B) was stained by anti-HBsAg in the cytoplasm of tubular cells.

Table 1.  The clinical and laboratory findings of the 360 patients with HBs-IgAN.

Characteristics
Age (years)	34 ± 12
Male	206 (57 %)
Follow-up duration (months)	72 ± 45
Proteinuria (g/24 h)	1.38 ± 2.1
Serum creatinine (mg/dL)	1.12 ± 0.66
eGFR (mL/min/1.73 m^2)	79 ± 28
Serum albumin (mg/dL)	3.82 ± 0.51
Serum alanine aminotransferase (IU/L)	19 ± 13
Uric acid (mg/dL)	5.9 ± 1.7
Total cholesterol (mg/dL)	195 ± 30
HBs antigenemia	22 (6.1%)
End-stage renal disease	24 (6.6%)

Table 2.  Comparison of baseline characteristics between idiopathic IgAN and HBs-IgAN.

		HBsAg(+)
	HBsAg(–)		HBV RM
	(n = 338)	Total	Negative (n = 13)	Positive (n = 9)	p-Value
Age	34 ± 12	37 ± 12	36 ± 11	38 ± 12	NS
Male, n (%)	190 (56)	16 (72)	10 (76)	6 (66)	NS
Follow-up duration (months)	71 ± 44	84 ± 52	79 ± 42	91 ± 66	NS
Proteinuria (g/24 h)	1.43 ± 2.2	1.16 ± 1.54	1.03 ± 0.92	1.35 ± 2.20	NS
Serum creatinine (mg/dL)	1.12 ± 0.67	1.12 ± 0.3	1.01 ± 0.22	1.27 ± 0.34	NS
Serum albumin (mg/dL)	3.82 ± 0.51	3.85 ± 0.44	3.94 ± 0.42	3.72 ± 0.46	NS
Serum ALT (IU/L)	18 ± 10	32 ± 31	21 ± 11	47 ± 14	0.01
Total cholesterol (mg/dL)	196 ± 134	180 ± 42	174 ± 32	190 ± 55	NS
IgG (mg/dL)	1226	1329	1277	1370	NS
IgA (mg/dL)	355	380	330	452	NS
IgM (mg/dL)	111	113	88	129	NS
C3 (mg/dL)	104	98	92	107	NS
C4 (mg/dL)	22	22	24	21	NS
Treatment
ACEi/ARB	338 (100)	22 (100)	13	9	NS
PDS	68 (20)	5 (23)	3	2	NS
eGFR decline/month (mL/min/per 1.73 m^2/month)	−0.01	−0.17	−0.22	−0.1	NS
End-stage renal disease	22 (6.5%)	2 (9%)	2 (15%)	0 (0%)	NS

Note: RM, replication marker such as HBeAg or HBV DNA; ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; PDS, prednisolone.

Figure 3.  (A) Comparison of renal survival between idiopathic IgAN and HBs-IgAN. There was no difference of renal survival between two groups. (B) Comparison of renal survival between three groups: a group with idiopathic IgAN, a group who had HBs-IgAN without HBVRM and a group had HBs-IgAN with HBV RM. There was no difference of renal survival between three groups.

Table 3.  The clinical and laboratory findings of 9 patients with HBV RM.

Patient number	Sex	Age	Follow-up (month)	ALT	Proteinuria (initial)	Proteinuria (last)	eGFR	ΔeGFR	Treatment
1	F	18	178	38	0.64	0.34	85	−0.19	Supportive
2	M	36	42	14	0.92	0.19	56	0.16	Supportive
3	M	20	52	23	0.80	0.03	93	−0.32	Supportive
4	M	34	158	67	1.44	0.1	71	−0.05	Lamivudine
5	M	56	67	31	0.85	0.19	44	−0.07	Lamivudine
6	M	48	11	25	7.12	2.66	39	−1.45	Entecavir
7	F	40	70	159	0.09	0.03	63	−0.30	Lamivudine
8	M	40	55	25	0.26	0.09	46	0.60	Lamivudine
9	F	50	192	43	0.03	0.05	61	0.08	Lamivudine

Note: ΔeGFR, eGFR at the first assessment was subtracted from eGFR at the end of follow-up and divided by the follow-up months.

Table 4.  Characteristics of patients with steroid therapy.

Patient number	HBV RM	WHO class	Cause of steroid Tx	Anti-viral therapy	HBV reactivation
1	Negative	IV	Deterioration of renal function	No	No
2	Negative	III	Deterioration of renal function	No	No
3	Negative	III	Deterioration of renal function	No	No
4	Positive	III	Deterioration of renal function	LAM → hold → LAM	Yes (after stopping LAM)
5	Positive	III	Nephrotic range proteinuria	ENV	No

Note: RM, replication marker such as HBeAg or HBV DNA; LAM, lamivudine; ENV, entecavir.

Figure 4.  (A) Comparison of eGFR between patients with anti-viral therapy and without. (B) Comparison of urinary protein excretion rate between patients with anti-viral therapy and without.