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Abstract: TH-PO1035

Clinical and Pathological Characteristics of Patients with HBV-Associated IgA Nephropathy: A Case Series

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Jurubita, Roxana Adriana, Fundeni Clinical Institute, Bucharest, Romania
  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Ion, Oana Catalina, Fundeni Clinical Institute, Bucharest, Romania
  • Andronesi, Andreea, Fundeni Clinical Institute, Bucharest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

A higher prevalence of hepatitis B surface antigen (HBsAg) is reported in patients with IgA nephropathy (IgAN) from endemic areas. However, little is known about the clinicopathological characteristics and outcome of these patients. We sought to characterize a cohort of patients with IgAN and HBsAg (HBsAg-IgAN).

Methods

Medical records of 110 patients with biopsy-proven IgAN, between 1999 and 2017, were retrospectively reviewed. Of these, 10 patients had HBsAg. Clinical and pathological characteristics (MEST-C score) at baseline, and outcomes were compared between HbsAg positive and negative IgAN patients.

Results

10 patients (9.1%) with HBsAg-IgAN (mean age: 47 ± 20 years) were identified in our cohort. Mean eGFR, hematuria, and 24-hour proteinuria were 47 ± 20 ml/min, 50 ± 60 RBC/μl and 2.3 ± 2.8 g/day, respectively. The percentage of patients that showed M1, E1, S1, T1 and C1 were 80%, 10%, 70%, 50% and 20%, respectively. By comparison to patients with HBsAg negative IgAN, there was a tendency towards a worse renal function at baseline with more severe features on kidney biopsy (fewer patients showing E lesions and more with crescents, segmental sclerosis and interstitial fibrosis). 30% of patients had a halving of eGFR (within 27 ± 20 months), versus 14% (within 45 ± 42 months) of patients with HBsAg negative IgAN. All patients received antiviral therapy, 40% having undetectable viral load at biopsy, 40% having a HBV-DNA below 1000 IU/l (mean 264 ± 357 IU/l) and 20% having over 1000 IU/l (mean 11000 ± 8680 IU/l). 40% of patients received additional immunosuppressive treatment (IS). There were no significant differences in terms of renal survival between those with high versus low viral replication and between those receiving antiviral therapy alone and combined antiviral/IS therapy. Additionally, patients receiving combined antiviral/IS therapy didn’t show any sign of HBV reactivation.

Conclusion

HBV-associated IgAN patients had a worse renal function at baseline, with more severe activity and chronicity features, both clinically and pathologically, as compared to HBsAg-negative IgAN patients. These characteristics determined a more rapid decline of renal function in our cohort of HBV-associated IgAN.