Hepatitis B e antigen-mediated membranous glomerulonephritis. Correlation of ultrastructural changes with HBeAg in the serum and glomeruli.

Immunopathologic findings in the glomeruli of six children with membranous glomerulonephritis who were carriers of hepatitis B virus were compared with serum markers of hepatitis B virus infection. Four of the patients were positive for hepatitis B e antigen (HBeAg) in the serum, were grossly proteinuric, and had abnormal liver function tests. Deposition of HBeAg, together with immunoglobulins and beta 1C, was found in the glomeruli of these patients. On electron microscopy, numerous electron-dense deposits were identified on and within the glomerular basement membrane. The remaining two patients were seropositive for antibody against HBeAg (anti-HBe); although they had previously suffered from active membranous glomerulonephritis with massive proteinuria, they were no longer proteinuric at the time of the last renal biopsy. Deposition of HBeAg was not detected in their glomeruli. Electron microscopic observation disclosed numerous electron-lucent areas which had replaced electron-dense deposits, indicating regression of the disease processes. These results delineate the etiologic role of HBeAg in maintaining active membranous changes and suggest that patients with HBeAg-mediated membranous glomerulonephritis may remit as they seroconvert from HBeAg to anti-HBe.