P0385CLINICAL DIFFERENCES OF MEMBRANOPROLIFERATIVE GLOMERULONEPHROPATHY (MPGN) ACCORDING TO PRESENCE OF HEPATITIS B VIRUS INFECTION

Abstract

Abstract Background and Aims Traditional definition of MPGN by morphologic changes on light microscopic examination was reclassified into MPGN caused by immunoglobulin/immune complex injury and C3 glomerulopathy (C3G) with alternative complement pathway abnormality based on immunofluorescence staining. MPGN might be caused by various causes such as malignancy, infection, autoimmune diseases, etc. It was rarely known the clinical characteristics of MPGN according to the possible causes excluding C3G. Method We enrolled 20,481 adult patients having native kidney biopsy for diagnosis of nephritis between 1979 and 2018, retrospectively. Among them, there were 553 patients with MPGN whom we reclassified into 18 patients with C3G and 535 MPGN patients. We excluded patients with cancer, autoimmune disease, hepatitis C virus infection, C3G, or combined pathologic diagnosis other than MPGN. Finally, we enrolled 156 patients without hepatitis B surface antigen (HBsAg)[MPGN] and 48 patients with HBsAg [MPGN_HBV]. The final outcomes were incidences of end stage renal disease (ESRD) and death. Results Patients with MPGN_HBV are younger than MPGN (45.5 ± 15.8 years vs 54.6 ± 15.7 years, p=0.001) and included more males (43 (89.6%) vs 97 (62.2%), p<0.001). The systolic blood pressure was not different between groups but the diastolic blood pressure was higher in MPGN_HBV (85.4 ± 10.4 mmHg vs 80.7 ± 13.4 mmHg, p=0.018). The level of urine protein to creatinine ratio was not different between groups but the level of glomerular filtration rate (GFR) was higher in patients with MPGN_HBV compared to patients with MPGN (65.8 ± 29.0 ml/min/1.73 m2 vs 57.5 ± 34.8 ml/min/1.73 m2, p=0.039). Mortality was observed in 2 patients with MPGN_HBV (4.2 %) and 9 patients with MPGN (5.8%)(p=1.000) during 64.9 months (median). Incident ESRD was notified in 6 patients with MPGN_HBV (13.3 %) and 39 patients with MPGN (26.5 %)(p=0.067) during 47.8 months (median). HBV positivity was not a risk factor to mortality (p=0.847) and was not a risk factor to incident ESRD (p=0.108), either, by Cox’s hazard proportional model adjusted with related factors to mortality. The most important risk factor was hemoglobin and GFR at renal biopsy. Conclusion The clinical characteristics of MPGN according to presence of HBsAg were different, however, the prognosis was not dependent on HBsAg positivity, which suggested the severity of renal injury was more important than the cause of renal injury.