GLOMERULONEPHRITIS ASSOCIATED WITH HEPATITIS-B SURFACE ANTIGEN IMMUNE COMPLEXES IN CHILDREN

Immunoglobulins and complement were identified by immunofluorescence in 32 of 52 unselected kidney-biopsy specimens from children with clinical nephrosis and/or glomerulonephritis (G.N.). Deposits with the composition and characteristics of viral hepatitis type B surface antigen (HBsAg)/antibody complexes were identified in 18 of these 32 specimens (56·2%). HBsAg immune complexes were found in endocapillary proliferative G.N. (2 of 13 cases), membranoproliferative G.N. (12 of 15 cases), membranous G.N. (2 of 2 cases), and endocapillary and extracapillary proliferative G.N. (2 of 2 cases). HBsAg was detected by immunoelectro-osmophoresis in the sera of 16 of these patients and antibody to hepatitis-B core antigen (anti-HBc) was detected by indirect immunofluorescence in all 18. The remaining 20 kidney-biopsy specimens were devoid of immunoglobulins, complement, and HBsAg or contained only trace amounts of immunoglobulins and complement. They all showed minimal glomerular lesions. Neither HBsAg nor anti-HBc were found in the sera of these patients. These findings strongly suggest that HBsAg immune complexes may play a primary pathogenic role in a significant number of glomerulonephritides in children subclinically infected with viral hepatitis type B.