Electrically heated gloves in children with Raynaud's phenomenon.

glomerulonephritis, three focal segmental glomerulosclerosis, one diffuse proliferative glomerulonephritis, and one membranoproliferative glomerulonephritis. All of the five patients with membranous glomerulonephritis were hepatitis B surface antigen positive and all were boys aged 5 to 9 years (mean 7.8). None responded to steriods but their natural history has been one of slow recovery. Three patients remitted spontaneously after an interval of one to three years, while the remaining two had persistent, mild, asymptomatic proteinuria. Renal function did not show any deterioration over a follow up period of one to five years in all patients. Our prevalence rate of 12% for membranous glomerulonephritis in children with nephrotic syndrome is quite high compared with that found by the International Study of Kidney Disease in Children in developed countries,5 but is comparable with areas where the incidence of hepatitis B surface antigen carrier status is high. Hepatitis B is endemic in Hong Kong and the prevalence of surface antigen positivity is 6-7%Yo in the first decade of life.' The associaition between childhood membranous glomerulonephritis and hepatitis B infection is very strong and all our patients with this were hepatitis B surface antigen positive. The mode of hepatitis B infection in these children is unknown. Vertical transmission is presumed to be the main infective mode responsible for childhood membrainous glomerulonephritis in Japan," while horizontal transmission is thought to be more important in Taiwain. None of our paitients had a previous history of hepatitis and the interval between the time of infection and the onset of symptoms of membranous glomerulonephritis cannot be determined. Interpretation of the results of hepatitis B marker screening of the family members at the time of. or after the diagnosis would be difficult. A long term, longitudinal follow up study of infected subjects is required to elucidate this. We are presently undertaking such a study to look for the causal and time relation between hepatitis B infection and the development of membranous glomerulonephritis in children.