Worldwide perspective of hepatitis B-associated glomerulonephritis in the 80s.

Chronic HBsAg carriers may develop glomerulonephritis (GN). Besides membranous GN (MGN), which seems a well established association, membranoproliferative GN (MPGN) or proliferative GN are also encountered in these patients. It is clear that the variations in the incidence of hepatitis B virus (HBV) GN may be real or related to a more or less vigorous search for HBV in the different nephrologic centers. However, the frequency of HBV GN in a country correlates with the underlying prevalence of HBV infection in the general population. Geographic patterns of HBV prevalence vary greatly from areas of low endemicity where less than 1% of adults are chronic carriers to areas of intermediate and high endemicity where between 2 and 15% of adults are chronic carriers. The most important factor affecting prevalence is age of HBV infection. The probability of becoming a chronic carrier is greater following infection during infancy and early childhood. The rarity of HBV GN in the U.S. and in western Europe probably reflects the rarity of HBV infection, especially in children. The frequency of HBV GN is high in Asian or Black children. It is possible to hope that, with the extensive immunization in countries of high endemicity, the frequency of HBV GN will diminish. In the U.S. and in Europe, patients with HBV GN frequently belong to high risk groups for HBV infection. In these countries, the increase in the percentage of HBV infection due to sexual transmission or linked with drug abuse may lead to an increase in the percentage of adult patients with HBV GN.