Concomitant nephrotic syndrome and tubulointerstitial nephritis in a child with Epstein-Barr virus mononucleosis.
Ratna AcharyaXu ZengKiran K UpadhyayPublished in: BMJ case reports (2021)
Acute kidney injury (AKI) and nephrotic syndrome (NS) are uncommon manifestations of Epstein-Barr virus (EBV) mononucleosis. We report a 4-year-old boy with Infectious mononucleosis (IM) who presented with dialysis-requiring AKI and NS. Renal biopsy showed severe acute tubular necrosis, mild chronic interstitial nephritis and focal podocyte foot processes effacement. EBV early RNA was not detected in the renal tissue. However, immunophenotyping of peripheral lymphocytes showed increased cytotoxic T cell activity and increased memory B cells. Treatment with steroid led to rapid resolution of NS within 3 weeks. Renal function stabilised. EBV viral capsid antigen (VCA) IgM remained elevated until 4 months before starting to decline when VCA IgG and nuclear antigen started appearing. B lymphocytes are the predominant target cells in EBV infection and additionally may also act as antigen presenting cells to T lymphocytes, thereby eliciting the strong immune response and leading to podocyte and tubulointerstitial injury.
Keyphrases
- epstein barr virus
- acute kidney injury
- diffuse large b cell lymphoma
- induced apoptosis
- immune response
- cell cycle arrest
- diabetic nephropathy
- dengue virus
- cardiac surgery
- peripheral blood
- sars cov
- chronic kidney disease
- mental health
- oxidative stress
- cell death
- zika virus
- working memory
- pi k akt
- endothelial cells
- replacement therapy