How frequent are hepatitis B virus markers in adult patients with glomerular diseases in a low endemic country? A French study from Paris and Saint-Brieuc.

In order to appreciate the frequency of hepatitis B virus (HBV) infection in patients with glomerular diseases in France, a low endemic country, we reviewed the series of patients biopsied in the years 1983-1989 in 2 departments of nephrology differing by the characteristics of the population. In Saint-Brieuc, where the population is almost exclusively Caucasian, with nearly no immigrant, HBsAg was not detected in any of the 86 patients. In Paris, a large number of patients come from highly or intermediately endemic regions. HBsAg was detected in 3 of 209 patients, 2 of the 75 patients with membranous nephropathy and 1 of the 32 patients with minimal-change nephrotic syndrome. These patients came from Africa and Asia. Therefore, in low endemic countries, the role of HBV infection in the etiology of glomerulonephritis is minimal. But, because of the late severity of the disease, screening remains essential in patients belonging to the high-risk groups.

[Safety of transfusion procedures: its various aspects, its various stages]. / La sécurité des actes transfusionnels: ses différents aspects, ses différentes étapes.

Despite considerable advances, transfusions still present major immunological and infectious dangers. Immunological accidents can be perfectly prevented by adhering to strict rules as regards the immediate risk, haemolysis, and satisfactorily prevented as regards late allo immunization. Safety concerning the transmission of viral or parasitic diseases is far from being absolute in spite of increasingly sophisticated tests performed on donors. This implies that transfusions should be restricted to clearly defined situations where the potential advantage overrides the risk and where the safest product can be chosen. This type of safety requires high quality blood products reflecting the high level of organization and technique of the Transfusion Centre. Finally, autotransfusion, the rules of which must be well-defined, may be an alternative in certain cases representing up to 10 p. 100 of all transfusions.

[Polycythaemia in a haemodialyzed anephric patient with hepatitis. Demonstration of erythropoietin secretion (author's transl)]. / Polyglobulie chez une Hémodialysée anéphrique aynat une hépatite. Mise en évidence d'une sécrétion d'érythropoïétine.

A 45-year-old woman who had undergone bilateral nephrectomy and splenectomy and who had been under haemodialysis since 1966 developed non-A non-B cytolytic hepatitis in October, 1978. Her haematocrit and haemoglobin levels had been stable at 39% and 6 g/dl respectively for more than one year when, two months after the onset of hepatitis, spontaneous improvement of anaemia was observed. This persisted side-by-side with hepatic cytolysis until march, 1980. At that time, the total red cell volume was 24% above normal, the haematocrit was 41% and the haemoglobin level 13 g/dl. It was than that serum erythropoietin was measured and found to be 82 mU/ml (normal values : 5-10 mU/ml). During the following months hepatic cytolysis and polycythaemia gradually subsided, and the serum erythropoietin level decreased. This case suggests that extrarenal erythropoietin can be secreted by the liver in anephric adults with uraemia, that hepatocytes undergoing regeneration after cytolysis in adults may have the same capability or erythropoietin secretion as in foetuses, and that in some haemodialyzed patients bone marrow responses to erythropoietin remains unaltered.

[B virus chronic hepatitis in the haemodialysed uraemic patient. Correlation between hepatic lesions and the presence of antigen e in 12 patients (author's transl)]. / Hépatite chronique à virus B chez l'urémique hémodialysé. Corrélation entre les lésions hépatiques et la présence de l'antigène e, chez 12 malades.

Twelve patients on haemodialysis for 6 months to 3 years contracted AgHBs positive hepatitis, 9 being also Ag e positive. They continued to carry the same antigens. Histological surveillance was begun from the 6th month of the disease onwards, with 2 to 4 repeated biopsies in 1,5 to 3,5 years in 9 patients, the last 3 having only one biopsy between the 8th and the 15th month. In 6 patients, the first biopsy revealed chronic persistent hepatitis (CPH) and in other 6 (5 male and 1 female) chronic aggressive hepatitis (CAH). Subsequent biopsies revealed cirrhosis in a patient treated with alphamethyldopa (Ag e +), the absence of any changes in 7 other patients (4 CPH including 3 Ag e + and 3 CAH including 2 Ag e +), and an improvement in the last. Long term surveillance of hepatitis B by repeated biopsies in haemodialysed patients reveals that histological lesions are stable at 2 years, that certain drugs may have an aggravating role and that Ag e has no prognostic value.