The immunopathogenesis of chronic membranous glomerulonephritis was investigated in a 42 yr old man with chronic active hepatitis, type B. In 2 renal biopsies, 14 mth apart, immunofluorescent study showed glomerular deposition of the hepatitis B antigen (HB Ag) and host IgG, IgM, and C3 in an irregular ''immune complex'' pattern. Electron microscopy showed dense deposits in the thickened basement membrane but no morphologic evidence of the intact, spherical, 20 nm HB Ag. Low concentrations of HB Ag were found in serial serum samples whereas total complement and component concentrations were normal. Most significantly, circulating HB Ag antibody complexes were directly shown by serum cryoprecipitation. Results of in vitro tests for a cell mediated immune response to HB Ag were negative. The potential importance of chronic hepatitis B virus infection as a primary cause of human immune complex glomerulonephritis is supported by these findings.
ASJC Scopus subject areas
- Internal Medicine