What types of viral hepatitis are associated with glomerulonephritis?
Chronic carriers of hepatitis B (HBV; 400 million people worldwide) or hepatitis C (HCV; 170 million people worldwide) are at increased risk of developing a variety of glomerular diseases linked directly to active viral replication. By definition, a carrier state for these viruses would be characterized by a positive quantitative polymerase chain reaction (PCR) assay.
For HBV, the common serologic markers used for identification of a chronic carrier state includes the presence of circulating hepatitis B surface antigen (HbsAg) and in some cases hepatitis B e antigen (HbeAg) and the absence of hepatitis B surface antibody (HbsAb). For HCV, the most common initial screening test is the enzyme-linked immunosorbent assay (ELISA) for hepatitis C IgG antibodies. In stark contrast to the importance of HbsAb as an indicator of previous exposure and their absence during a chronic carrier state for HBV, the presence of HCV ELISA antibodies usually means the presence of active viremia, since this HCV antibody is non-neutralizing.
Importantly, here is a small subgroup of patients (5% to 7%) who do not mount an antibody response to HCV, yet are chronic carriers by PCR. This is especially true for patients with end-stage kidney disease; therefore if a kidney lesion is suspicious for HCV related-glomerulonephritis, then a PCR should be done even if the ELISA is negative.
