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

Pediatr Nephrol. 2003 Jul;18(7):667-74. doi: 10.1007/s00467-003-1152-y. Epub 2003 May 15.

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 virus-associated 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.

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / therapy
  • Anti-Inflammatory Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Blood Urea Nitrogen
  • Child
  • Child, Preschool
  • Epstein-Barr Virus Infections / complications
  • Epstein-Barr Virus Infections / diagnosis*
  • Epstein-Barr Virus Infections / therapy
  • Female
  • Histiocytosis, Non-Langerhans-Cell / complications
  • Histiocytosis, Non-Langerhans-Cell / diagnosis
  • Histiocytosis, Non-Langerhans-Cell / therapy
  • Humans
  • Immunoglobulins / therapeutic use
  • Infant
  • Kidney / pathology
  • Kidney Function Tests
  • Kidney Tubular Necrosis, Acute / etiology
  • Kidney Tubular Necrosis, Acute / pathology
  • Male
  • Prednisolone / therapeutic use
  • Proteinuria / etiology
  • Retrospective Studies

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Immunoglobulins
  • Prednisolone