J Korean Soc Pediatr Nephrol.  2008 Apr;12(1):88-92.

Membranous Nephropathy Associated with Epstein-Barr Virus Infection in a Child

• Lee EH
• Lim DH
• Yim HE
• Yoo KH
• Won NH
• Hong YS
• Lee JW

Abstract

Infection of Epstein-Barr virus(EBV) gives rise to a broad spectrum of clinical manifestations in children. Although renal involvement is rare, diverse renal manifestations are known from hematuria to acute renal failure. Secondary membranous nephropathy(MN) associated with systemic EBV infection is an uncommon renal pathology and only two cases have been reported. We are adding another case of MN associated with EBV infection in a child. An 8-year-old girl was admitted for renal biopsy. She had been followed up for microscopic hematuria and intermittent proteinuria for 5 months. There had been no specific findings in serology and radiology. Tonsil biopsy had been done due to exudative tonsillar hypertrophy and enlarged multiple cervical lymph nodes. And it showed EBV-associated lymphoproliferative findings. Serologic tests for EBV showed positive evidence of recent infection; viral capsid antigen(VCA) IgM was borderline positive, VCA IgG and early antigen IgG were positive, and EB nuclear antigen IgG was negative. In Situ Hybridization of tonsil for EBV mRNA was positive. Because her proteinuria and hematuria were aggravated at that time(protein 3+, RBC >60/HPF), renal biopsy was done. Renal biopsy showed the findings of MN, characterized by thickened capillary walls with epimembranous spikes on light microscopy and subepithelial, mesangial and subendothelial electron dense deposits on electron microscopy. On immunofluorescence microscopy, IgG, C1q, kappa and lambda chains were positive. After steroid administration, proteinuria and hematuria resolved gradually within 6 months.

Keyword

Epstein-Barr virus; Membranous nephropathy

MeSH Terms

Acute Kidney Injury
Biopsy
Capillaries
Capsid
Child
Electrons
Epstein-Barr Virus Infections
Glomerulonephritis, Membranous
Hematuria
Herpesvirus 4, Human
Humans
Hypertrophy
Immunoglobulin G
Immunoglobulin M
In Situ Hybridization
Light
Lymph Nodes
Microscopy
Microscopy, Electron
Microscopy, Fluorescence
Palatine Tonsil
Proteinuria
RNA, Messenger
Serologic Tests
Immunoglobulin G
Immunoglobulin M
RNA, Messenger