Can a specific kidney disease detected without a kidney biopsy in chronic HBV

Can a specific kidney disease detected without a kidney biopsy in chronic HBV?

Ultimately, a kidney biopsy is needed to be certain of the diagnosis. However, among the different possibilities, both MN and FSGS are associated with the nephrotic syndrome while MPGN and IgA present with a nephritic urinary sediment. Polyarteritis nodosa (PAN) does not cause changes in the urinalysis, since the lesion is a vasculitis in larger blood vessels extrinsic to the glomerulus.

When the diagnosis is MN on biopsy, the question arises as to whether this could be idiopathic MN occurring by chance in a patient with HBV. Treatment options are contingent on which one is the cause. Patients with idiopathic MN are predominantly positive for anti-phospholipase A2 receptor antibodies compared to mostly negative results in HBV MN. However, there is enough overlap in published studies to raise a question about the predictive accuracy of this assay.

In spite of HBV-related immune complexes being present in MN, MPGN, and PAN, systemic complement activation is not seen, and C3 and C4 levels remain normal. Low complement levels should raise concern for unsuspected co-infection with HCV.

15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856