Human parvovirus B19 infection associated with hemolytic uremic syndrome

Abstract

A 59-year-old woman developed hemolytic uremic syndrome (HUS) associated with acute human parvovirus B19 (HPVB19) infection. A renal biopsy revealed glomerular mesangiolysis with segmental hypercellularity; mild fibrinogen/fibrin deposits were noted by immunofluorescence study and severe endothelial injury was noted electron microscopically. The histological findings were compatible with HUS. We discuss the relation of HPVB19 to HUS, with special reference to the tropism of the virus for endothelial cells.

Nephrotic syndrome associated with human parvovirus B19 infection

“…The authors referred to a previous similar report published in 1978 [2]. PVB19 infection has also been associated with hemolytic uremic syndrome in adults without any underlying diseases [6,7] and with another form of thrombotic microangiopathy in four patients (including one adolescent) under immunosuppression after renal transplantation [8]. Focal segmental glomerulosclerosis (FSGS) was found in one.…”

Renal involvement in human parvovirus B19 infection

“…A renal biopsy revealed mesangiolysis with segmental hypercellularity, absent glomerular deposition of immunoglobulin or complement, and endothelial injury without glomerular electron-dense deposits. From these findings, direct B19 injury to endothelial cells is likely to have induced TMA in the patients of Murer et al [12] and Iwafuchi et al [13]. However, Seward et al [14] described a patient with HUS following B19 infection with hypocomplementemia and proliferative glomerulonephritis with granular deposition of immunoglobulin in the capillary tufts.…”

“…B19 genome was isolated from renal tissues of these patients. Iwafuchi et al [13] reported a patient with hemolytic uremic syndrome (HUS) associated with acute B19 infection. A renal biopsy revealed mesangiolysis with segmental hypercellularity, absent glomerular deposition of immunoglobulin or complement, and endothelial injury without glomerular electron-dense deposits.…”

Parvovirus B19-induced multisystemic vasculitis and acute endocapillary proliferative glomerulonephritis in a child

“…9,10 Murer et al reported a relationship between HPVB19 infection and another form of thrombotic microangiopathy in four patients (including one adolescent) under immunosuppression after renal transplantation.…”

“…2,3 Renal involvement in patients with HPVB19 infection was not discussed in early reports, but a causal relationship between this infection and acute glomerulonephritis has been suggested in recent, mostly anecdotal, case reports. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The majority of these reports were described in adults, whereas only a few cases of children were defined who presented with mesangiocapillary proliferative glomerulonephritis, focal segmental glomerulosclerosis (FSGS), or tubulointerstitial nephritis. We present the first pediatric case of acute endocapillary proliferative glomerulonephritis (AEPGN) induced by HPVB19 that did not resolve spontaneously.…”