Characterization of proteinuria in asymptomatic family members and household contacts of children with hepatitis B virus-associated membranous nephropathy.
The biosocial background in which the hepatitis B virus (HBV) carrier state with membranous nephropathy (MN) develops was studied by evaluating HBV carriage and proteinuria among 195 family members and household contacts of 31 index HBV carrier children with MN. Unrelated individuals from the communities of these index cases who were negative for HBV served as controls (n = 123). HBV was determined by using third-generation enzyme-linked immunosorbent assay, slot-blot hybridization, and nested polymerase chain reaction. Patterns of proteinuria were determined by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis; immunoglobulin G and haptoglobulin were suggestive of MN. Seventy-two members (36.9%) of the study group (n = 195) were HBV carriers; 21 of these carriers (29.2%) had proteinuria. Twenty-eight members (41.2%) of the study group who were HBV negative (n = 68) and 26.8% of the controls showed proteinuria. This lack of association between HBV carriage and proteinuria remained when controlled for sex and family relationship. HBV was not protective against the development of proteinuria. Proteinuria suggestive of MN was strongly associated with an abnormal protein-creatinine ratio (P: = 0.001), but was not significantly different between subjects and controls (8.7% versus 6.5%; P: = 0.5). Genetic influences or environmental exposures in these subjects may be responsible for the proteinuria, suggesting underlying glomerular basement membrane damage. Discordance between the HBV carrier state and patterns of proteinuria in the study group suggest that HBV and MN may not be causally related or may reflect exceptional interaction between specifically vulnerable individuals and HBV.
Bhimma
R
R
Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Congella, South Africa. Bhimma@med.und.ac.za  
Coovadia
H M
HM
Ramjee
G
G
Kramvis
A
A
Adhikari
M
M
Kew
M C
MC
Connolly
C A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018562:Disease Transmission, Infectious; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications*; D006509:Hepatitis B / Q000150:complications* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000145:classification* / Q000209:etiology*