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Abstract: PO1864

Membranoproliferative Glomerulonephritis (MPGN) Associated with Epstein Barr Virus (EBV)

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Al faris, Faris, Albany Medical Center, Albany, New York, United States
  • Shahzad, Sheikh Raza, Albany Medical Center, Albany, New York, United States
  • Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States
  • Hongalgi, Krishnakumar D., Albany Medical Center, Albany, New York, United States
  • Mehta, Swati, Albany Medical Center, Albany, New York, United States
  • Salman, Loay H., Albany Medical Center, Albany, New York, United States
  • Beers, Kelly H., Albany Medical Center, Albany, New York, United States
Introduction

Immune complex-mediated MPGN has been commonly associated with viral infections including Hepatitis B, C, HIV and Hantavirus. We present a rare case of EBV associated MPGN successfully treated conservatively.

Case Description

A 19-year old female, previously healthy, presented with fatigue, sore throat and periorbital swelling for 3 weeks. Vitals were stable on presentation. Her EBV IgM and IgG serologies were positive while CMV was negative. UA showed proteinuria (>300mg/dL) and microscopic hematuria. Albumin was 2.9 g/dL. Spot urine protein to creatinine ratio was 2.6g/g. Urine sediment was bland. SCr was 0.72 mg/dL. Extensive serological work up was negative. Renal biopsy showed mesangial hypercellularity, double contours of capillary loops with intramembranous, subendothelial and subepithelial immune type electron dense deposits. Immunofluorescence revealed segmental globular to coarsely granular staining in the glomerular capillary walls for IgG (3+), IgA (1+), IgM (3+), kappa (2+), lambda (3+), C3 (1-2+), C1q (3+), and C4 (1+). Mesangial regions showed segmental granular staining for IgG (1+), kappa (1+), lambda (1+) and C4 (1+).
She was treated with furosemide 20mg daily as needed for swelling and lisinopril 5mg daily. Her symptoms resolved within 2 weeks of initiating treatment. She self-discontinued her medications after 4 months. On 6 month follow up, she remained asymptomatic and urine protein was undetectable.

Discussion

Infectious Mononucleosis (IM) is caused by EBV. EBV primarily infects human B cells via the CD21 receptor and may infect renal tissue since the CD21 molecule has been detected in proximal tubular cells of kidneys. Further, acute EBV infection may cause immune-mediated response with deposition of immune complexes and subsequent glomerulopathy. Renal involvement is reported with 3-16% cases of acute IM. Common renal lesions include acute tubulointerstitial nephritis, membranous nephropathy, minimal change disease and vasculitic lesions. MPGN is a rare presentation of EBV and should be considered in patients with IM and proteinuria. Previous case reports have suggested that nephrotic syndrome in patients with an acute EBV infection is usually self-limiting. Our case report also suggests that MPGN associated with EBV may have a relatively benign course.