Epstein-Barr virus-associated acute renal failure: diagnosis, treatment, and follow-up.
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.
Department of Pediatrics, Taipei Medical University and Mackay Memorial Hospital, Taipei, Taiwan.
Jeng-Daw
JD
Tsai
Hung-Chang
HC
Lee
Chun-Chen
CC
Lin
Der-Cherng
DC
Liang
Shu-Huey
SH
Chen
Fu-Yuan
FY
Huang
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007223:Infant; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology / Q000473:pathology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D007136:Immunoglobulins; D011239:Prednisolone