Hepatitis B virus-related nephropathy and lupus nephritis: Morphologic similarities of two clinical entities

We compared the clinicopathologic features of 22 patients with hepatitis B virus-related membranous nephropathy, all with detectable glomerular hepati tis B e antigen, and of 26 patients with lupus nephritis class V. Both grou ps of patients similarly presented with heavy proteinuria or nephrotic synd rome; however, the patients with hepatitis B virus-related membranous nephr opathy, who were predominantly male, did not have the extrarenal manifestat ions and autoantibodies seen in systemic lupus erythematosus, The glomerula r lesions in both clinical entities were similar and at times indistinguish able, demonstrating polyclonal immunoglobulins and polytypic complements in similar subepithelial ultrastructural distribution. No morphologic feature , single or combined, carrying a high positive predictive value for the dia gnosis of either nephritis was identified. Lesions such as hematoxyphil bod ies and fingerprint dense deposits, distinctive of systemic lupus erythemat osus, were rarely found. At the time of biopsy, when systemic lupus erythem atosus is not clinically suspected, the diagnosis between hepatitis B virus -related membranous nephropathy and lupus nephritis may be difficult or imp ossible to differentiate, especially in geographic areas where both lupus n ephritis and hepatitis B surface antigen carriers are common. This study fo cused on the use of specific monoclonal antisera to detect glomerular hepat itis B virus antigens, which contribute to the diagnosis of hepatitis B vir us-related nephritis.