Hepatitis B 's' and 'e' antigen carriage in childhood nephrotic syndrome predicts membranous glomerulonephritis.

Among 178 African children with nephrotic syndrome, membranous nephropathy was the commonest histological lesion (60 children; 34%). Fifty-seven (95%) of these 60 were hepatitis B surface antigen (HBsAg)-positive, and 52 (86%) of these 57 were hepatitis B 'e' antigen (HBeAg)-positive. HBsAg was detected in only six (5%) and HBeAg in one (0.8%) of the 118 patients with non-membranous lesions. The risk of membranous nephropathy was 35 and 15 times higher in the 178 African children with nephrotic syndrome who had serological evidence of HBsAg and HBeAg, respectively, than in those who did not. Sensitivity was 95% for HBsAg and 87% for HBeAg; specificity, and positive and negative predictive values were above 90% for each antigen. The strength of such an association in this particular community permits reliable prediction of membranous nephropathy from serological tests for HBsAg and HBeAg, thereby avoiding renal biopsy.