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Journal of the Korean Society of Pediatric Nephrology 2008;12(1): 88-92. doi: https://doi.org/10.3339/jkspn.2008.12.1.88
소아에서 엡스타인-바 바이러스 감염과 관련한 막성 신병증 1례
이은희, 임동희, 임형은, 유기환, 원남희, 홍영숙, 이주원
1고려대학교 의과대학 소아과학교실
2고려대학교 의과대학 소아과학교실
3고려대학교 의과대학 소아과학교실
4고려대학교 의과대학 소아과학교실
5고려대학교 의과대학 병리과학교실
6고려대학교 의과대학 소아과학교실
7고려대학교 의과대학 소아과학교실
Membranous Nephropathy Associated with Epstein-Barr Virus Infection in a Child
Eun-Hee Lee, Dong-Hee Lim, Hyung-Eun Yim, Kee-Hwan Yoo, Nam-Hee Won, Young-Sook Hong, Joo-Won Lee
1Department of Pediatrics, College of Medicine, Korea University
2Department of Pediatrics, College of Medicine, Korea University
3Department of Pediatrics, College of Medicine, Korea University
4Department of Pediatrics, College of Medicine, Korea University
5Department of Pathology, College of Medicine, Korea University
6Department of Pediatrics, College of Medicine, Korea University
7Department of Pediatrics, College of Medicine, Korea University
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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.
Key words: Epstein-Barr virus | Membranous nephropathy
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