To evaluate the risk of hepatitis B virus (HBV) activation in patients with glomerulonephritis (GN) receiving regular immunosuppressive therapy, and to provide data for more reasonable immunosuppressive therapeutic regimens in patients complicated with HBV infection.

Between January 2006 and December 2013, a total of 275 patients with GN were recruited, who were diagnosed by renal biopsy in the Affiliated Hospital to Guangdong Medical College, and divided into HBsAg positive group (102 cases) and HBsAg negative group (173 cases). HBsAg positive patients were further divided into Pred group, Pred+ CTX group, Pred+ AZA and/or TwHF group, whose incidences of liver injury were compared among them. HBsAg positive patients were also divided into antiviral group and non-antiviral group, whose incidences of liver injury were compared between them. The logistic regression statistical method was applied to analyze the risk factors for hepatitis activation.

The incidences of liver injury in HBsAg positive and negative groups were 32.4% (33/102) vs 7.6% (13/172), respectively, the difference of wghich was statistically significant (χ²=28.421, P<0.001). 78.4% of the liver injury in HBsAg positive patients occurred within 6 months after receiving immunosuppressive therapy. The incidence of liver injury in the Pred+ CTX group [66.7% (6/9)], was not significantly higher than those in the Pred group [37.8%(23/61)] and in the Pred+ AZA and/or TwHF group [25% (8/32)] (χ²=5.41, P=0.067). And it was found that the immunosuppression therapy regimen was a risk factor for HBV activation (OR=7.501, P=0.027). The baseline levels of ALT (t=3.133, P=0.03) and the percentage of patients with HBV-DNA copies over 10⁵/mL (χ²=15.174, P<0.001) were both higher in the antiviral group than in the non-antiviral group. After the immunosuppressive therapy treatment, the incidence of liver injury was not significantly higher in the antiviral group [47.5% (19/40)] than in the non-antiviral group [29% (18/62)] (P>0.05).

GN patients with positive HBsAg were at high risk for HBV activation during immunosuppressive therapy, especially in the first six months. So the serum HBV-DNA level and the liver function monitoring should be strengthened in these patients. CTX may expose HBsAg positive patients to the risks of HBV activation and hepatotoxicity.Prophylactic antiviral therapy can reduce HBV-DNA replication, but seems to fail in reducing the incidence of liver injury. More prospective studies are still needed to confirm the value of prophylactic antiviral therapy for GN patients with HBV infection.