A 30-year-old man from an endemic region presents with nephrotic syndrome. Serology shows HBsAg positivity. Renal biopsy demonstrates thickened capillary walls with subepithelial deposits, and immunofluorescence reveals IgG, IgM and prominent C3 with hepatitis B surface and e antigens identified within the deposits. What is the most likely diagnosis?

• A Idiopathic membranous nephropathy with incidental HBV carriage
• B Hepatitis B virus associated membranous nephropathy ✓
• C Hepatitis B associated membranoproliferative glomerulonephritis
• D Lupus nephritis class V triggered by hepatitis B infection

Explanation

Chronic hepatitis B is a well established cause of secondary membranous nephropathy, particularly in children and young adults in endemic areas. Viral antigens such as HBsAg and HBeAg have been demonstrated within the subepithelial immune deposits, confirming a causal role rather than coincidental carriage. Hepatitis B more commonly produces membranous than proliferative lesions, and lupus nephritis class V requires serologic and histologic evidence of lupus, which is absent here.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.