소아에서 엡스타인-바 바이러스 감염과관련한 막성 신병증 1례
Membranous Nephropathy Associated withEpstein-Barr Virus Infection in a Child
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초록
막성 신병증은 성인에 비해 소아에서는 드문 신병증으로 감염, 자가면역, 종양에 의한 이차성 신병증이 알려져 있다. 그 중에서도 엡스타인-바 바이러스 감염과의 관련은 잘 알려지지 않아, 최근 1개 보고에서 면역기능이 저하된 2례를 소개한 바 있을 뿐이다. 이에 저자들은 면역기능이 정상으로 보이는 소아에서 엡스타인-바 바이러스 감염과 관련한 막성 신병증 1례를 경험하였기에 보고하는 바이다.
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.
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