Epstein-Barr virus-associated acute renal failure: diagnosis, treatment, and follow-up

Abstract

We retrospectively reviewed our experience of Epstein-Barr virus (EBV)-associated acute renal failure. Of 165 previously healthy children hospitalized with serologically proven primary EBV infection, 8 had acute renal failure, of whom 5 (group A) did not have virusassociated hemophagocytic syndrome (VAHS), while 3 (group B) did have VAHS. All had complications in four or more organ systems. Two patients in group A had renal biopsies showing acute tubulointerstitial nephritis, and the clinical and laboratory findings in the other 3 group A patients were consistent with acute tubulointerstitial nephritis. Acyclovir was used in 1 patient, but she died of hepatic failure and pulmonary hemorrhage. The other 4 spontaneously recovered renal function after supportive care, including hemodialysis in 1 patient. Our experience does not support the routine use of corticosteroids or antiviral agents in these patients. Children in group B had a relatively normal urinalysis. Renal biopsies were not performed, but their presentations were compatible with acute tubular necrosis. We conclude that EBV should be considered as a possible etiological agent in all children presenting with acute renal failure of unknown cause. The diagnosis depends on a high index of suspicion and careful serological evaluation in atypical cases.

Viral nephropathy

“…64 More commonly, hepatitis A virus induces acute renal failure secondary to acute fulminant hepatitis. 65 Acute renal failure complicating other viral infections, such as Epstein-Barr virus 66 and dengue fever, 67…”

Clinical features of renal damage associated with Epstein-Barr virus infection in children

“…The relationship between the re-emerging fatal renal failure and the EBV infection from several years ago evokes associations with previously reported cases. A researcher from a hospital in Taipei, China reported eight cases of acute renal failure in EBV-infected pediatric patients within 6 years, and two of these patients eventually died ( 7 ). This suggests that EBV infection-induced severe kidney damage is not uncommon and can seriously affect the prognosis if not treated aggressively.…”

Concomitant nephrotic syndrome and tubulointerstitial nephritis in a child with Epstein-Barr virus mononucleosis

“…In children, a few reports have described the various manifestations of EBV-associated nephropathy. A retrospective study of 165 children with primary EBV infection reported an AKI incidence of 5%, with TIN being the most common renal histology 4. NS in association with EBV infection was described in a 19-month-old girl who had resolution of proteinuria with abatement of EBV 3.…”