Журнал "Почки" том 10, №3

More documents

Recommendations

Info

Êë³í³÷íå ñïîñòåðåæåííÿ / Clinical ObservationTable 1. Evolution of blood test and urine dipsticks from the first ER visit. Hospitalisation is day 2 onwardsDay from 1 st ER visit 0 2 4 6Blood testUrine dipstickUrea (mg/dl) 29 54 32 14Creatinine (mg/dl) 1.2 2.5 1.4 1GFR (mL/min/1.73 m 2 ) 76.43 33 64 94Platelets (1000/mm 3 ) 43 72 161 271AST (UI/L) 82 194 127 33ALT (UI/L) 77 272 304 152CRP 28.6 14.9 14.2 8.6pH 6 5 5Haemoglobin ++ ++ 0Protein +++ ++ 0and borderline positive IgM levels, which we interpreted asbeing recovery from an initial infection ( his symptoms havingstarted a week before the blood test/antibody serologywas performed).The patient had presented to the ER two days prior witha 38.5 °C fever. A non-contrast CT-scan was performed,which was unremarkable. A blood test was performed, visiblein table 1 as day 0. His blood test revealed a thrombocytopeniaof 43 000/mm 3 , a low white blood cell count of4 300/mm 3 , ALT 82 U/L, ALT 77 U/L, CRP 28.6 mg/L,creatinine of 1.2 mg/dL, and an estimated creatinine clearancerate of 76.43 mL/min/1.73m 2 . He also had a mildhyponatraemia at 133 mmol/L and hypochloraemia at92.4 mmol/L.Upon his second presentation two days later he stillhad a thrombocytopenia at 71 000/mm 3 , a recovered whiteblood cell count of 6 100/mm 3 , worsened liver tests of ALT194 U/L, ALT 272 U/L, and an improved CRP 14.9 mg/L.His kidney function, however, had rapidly degraded with acreatinine of 2.5 mg/dL and an estimated creatinine clearancerate of 33 mL/min/1.73 m 2 . He remained hyponatraemicand hypochloraemic with 127 mmol/L and 89 mmol/Lrespectively. Anti-nuclear antibodies (ANA) and antineutrophilcytoplasmic antibodies (ANCA) were tested to ruleout an auto-immune origin, with both returning negativeresults. A urine dipstick was performed, revealing a pH of 5,2 crosses of protein and 2 crosses of haemoglobin, with nosigns of a urinary tract infection.Two days following admission, the patient’s renal testsspontaneously began to improve, and he required no furthertreatment. Due to the improvement in renal function, a renalbiopsy was not performed.On the 6 th day of hospitalisation, the patient was discharged,having fully recovered.DiscussionEBV, the causative agent of mononucleosis, is generallyself-limiting and typically presents with a triad of fever,pharyngitis and cervical adenopathy, though complicationsmay occur and involve other organ systems [1].When our patient presented at the emergency departmentit is likely that they had already been ill for some timeas the IgM to IgG shift had already occurred, with hepaticand renal involvement also present.Our patient presented with both typical and atypicalsigns of EBV infection, having had the typical fever, pharyngitis,fatigue, and hepatic enzyme elevation with the atypicalsigns being abdominal pain, and acute renal failure. Notably,we observed no cervical adenopathy.Previous studies of students of similar ages to our patientalso found most patients suffered from pharyngitis, pyrexiaand cervical adenopathy, with less than half suffering fromcough and only 15 % presenting with abdominal pain [1].Other studies found haematuria and proteinuria in 11 and14 % of patients respectively, making it an even rarer occurrence,our patient presenting with both simultaneously [4].Although our patient had taken ibuprofen and vomitedonce, we do not believe this caused the renal failure as it progressedin the days following hospitalisation at which timethe medication has been stopped and the patient rehydrated.We also believe that the presence of protein and blood in theurine dipstick pleads against simple dehydration being thecause of the renal failure.The physiopathology of EBV associated kidney failureis thought to result from interstitial nephritis with two possibleexplanations being put forward [5]. The first of thesesuggests that the kidney is subject to an attack by T-lymphocytestargeting infected lymphocytes presenting EBVantigens which are passing through it [5]. The second hypothesisis that EBV directly infects renal cells, causing anauto-immune response against the infected cells, resultingin the kidney damage and subsequent failure [4]. Case reportsof EBV related kidney failure in which biopsies wereperformed, though heterogenous in nature, revealed interstitialinfiltrates without much glomerular involvement [5].The patient very briefly presented with mild anemia afew days after admission and at one point had slightly elevatedconjugated bilirubin. We did not make a clinical diagnosisof anemia.We did not consider HUS as a possible diagnosis due tothe lack of a history of diarrhea and the anemia being verymild and transient.Corticosteroids use can be found in many case reports,with some finding that there is marked improvement after108 Íèðêè, ISSN 2307-1257 (print), ISSN 2307-1265 (online) Òîì 10, ¹ 3, 2021
Êë³í³÷íå ñïîñòåðåæåííÿ / Clinical Observationadministration, though others note that their use is debatablefor the treatment of EBV in general, as well as in thecontext of EBV induced renal failure [1, 2, 6]. Our patientrecovered spontaneously within 5 days, lending more credenceto the argument that treatment may not be necessary.As this was the case, no renal biopsies were taken.ConclusionsIn conclusion, this case is an example of an uncommoncomplication of EBV. Though the acute renal failure maybe rapid, it does not necessarily require treatment and insome cases, patients can fully recover with only supportivecare.References1. Dunmire S.K., Verghese P.S., Balfour H.H. Primary Epstein-Barr virus infection. Journal of Clinical Virology. Elsevier B.V. 2018.Vol. 102. Р. 84-92.2. Kien C., Ganta K. An Atypical Presentation of Epstein-Barr VirusAssociated Infectious Mononucleosis Mistaken for Pyelonephritis.Cureus [Internet]. 2020, Apr 8 [cited 2021, Jun 20]. 12(4). Availablefrom: /pmc/articles/PMC7212761/.3. Tidy H.L., Morley E.B. Glandular fever. Br. Med. J. [Internet].1921, Apr 18 [cited 2021, Jun 20]. 1(3143). 452-456. Available from:https://www.bmj.com/content/1/3143/452.4. Dylewski J., Roy I., Eid J. Acute renal failure associated withacute epstein-barr virus infection. Infect. Dis. Clin. Pract. [Internet].2008 Mar [cited 2021, Jun 20]. 16(2). 127-128. Available from:https://journals.lww.com/infectdis/Fulltext/2008/03000/Acute_Renal_Failure_Associated_With_Acute.13.aspx.5. Mayer H.B., Wanke C.A., Williams M., Crosson A.W., FedermanM., Hammer S.M. Epstein-Barr Virus-Induced InfectiousMononucleosis Complicated by Acute Renal Failure: Case Report andReview [Internet]. 1996 [cited 2021, Jun 20]. Available from: https://academic.oup.com/cid/article/22/6/1009/465411.6. Lei P.S., Lowichik A., Allen W., Mauch T.J. Acute renal failure:Unusual complication of Epstein-Barr virus-induced infectiousmononucleosis. Clin. Infect. Dis. [Internet]. 2000, Dec 1 [cited 2021,Jun 20]. 31(6). 1519-1524. Available from: https://academic.oup.com/cid/article/31/6/1519/373063.Received 28.07.2021Revised 08.08.2021Accepted 09.08.2021Information about authorsTom Saliba, Medical Student in 1st year of specialisation in radiodiagnostics, Université Libre de Bruxelles, Bruxelles, Belgium; e-mail: Thomas.saliba@ulb.be; https://orcid.org/0000-0001-6989-9577.Albert Huard, MD, Head of internal medicine department, CHIREC Braine-L’Alleud, Belgium; e-mail: alberthuard@compaqnet.beConflicts of interests. The authors declare having no competing interests.Information about funding. No funding was provided for the creation of this work.Tom Saliba, Albert HuardInternal Medicine Department, CHIREC, Braine-L’Alleud, BelgiumÃîñòðà íèðêîâà íåäîñòàòí³ñòü, ùî ðîçâèíóëàñü íà òë³ â³ðóñó Åïøòåéíà — Áàððó çäîðîâîãî 21-ð³÷íîãî ÷îëîâ³êà: êë³í³÷íèé âèïàäîêРезюме. Вірус Епштейна — Барр (ВЕБ) вражає 9 із 10 осібв якийсь момент їх життя. Хоча зазвичай перебіг інфекціїсприятливий, вона може проявлятися безліччю симптомів йускладнень. Ми наводимо випадок ВЕБ у раніше здорового21-річного чоловіка, у якого протягом 8 днів спостерігалисядисфагія, фарингіт, кашель, болі в животі і стомлюваність, араніше також підвищувалася температура, що досягала максимальногозначення 38,5 °С. При клінічному огляді відзначенотільки хворобливість живота. Під час госпіталізації з приводуВЕБ у пацієнта раптово виникла ниркова недостатність,що спостерігалася протягом 4 днів, швидкість клубочковоїфільтрації знизилася до 33 мл/хв/1,73 м 2 , а згодом довільновідновилася до нормального рівня. Це сталося лише при підтримуючомулікуванні без застосування кортикостероїдів. Данийвипадок ілюструє атиповий перебіг інфекції ВЕБ і становитьсобою приклад спонтанної нормалізації функції нирок.Ключові слова: вірус Епштейна — Барр; мононуклеоз; гостраниркова недостатність; кортикостероїдиTom Saliba, Albert HuardInternal Medicine Department, CHIREC, Braine-L’Alleud, BelgiumÎñòðàÿ ïî÷å÷íàÿ íåäîñòàòî÷íîñòü, ðàçâèâøàÿñÿ íà ôîíå âèðóñà Ýïøòåéíà — Áàððó çäîðîâîãî 21-ëåòíåãî ìóæ÷èíû: êëèíè÷åñêèé ñëó÷àéРезюме. Вирус Эпштейна — Барр (ВЭБ) поражает 9 из 10 человекв какой-то момент их жизни. Хотя обычно течение инфекцииблагоприятное, она может проявляться множествомсимптомов и осложнений. Мы представляем случай ВЭБ уранее здорового 21-летнего мужчины, у которого в течение 8дней наблюдались дисфагия, фарингит, кашель, боли в животеи утомляемость, а ранее также повышалась температура,достигавшая максимального значения 38,5 °С. При клиническомосмотре отмечена только болезненность живота. Во времягоспитализации по поводу ВЭБ у пациента внезапно возниклапочечная недостаточность, наблюдавшаяся в течение 4дней, скорость клубочковой фильтрации снизилась до 33 мл/мин/1,73 м 2 , а впоследствии произвольно восстановилась донормального уровня. Это произошло лишь при поддерживающемлечении без применения кортикостероидов. Данныйслучай иллюстрирует атипичное течение инфекции ВЭБ ипредставляет собой пример спонтанной нормализации функциипочек.Ключевые слова: вирус Эпштейна — Барр; мононуклеоз;острая почечная недостаточность; кортикостероидыÒîì 10, ¹ 3, 2021www.mif-ua.com, http://kidneys.zaslavsky.com.ua 109
Page 3 and 4:
Національний уніве
Page 5 and 6:
Editor-in-ChiefDmytro D. IvanovSpec
Page 7 and 8:
Çì³ñò / Contents²âàíîâ
Page 9:
Ñòîð³íêà ðåäàêòîðà
Page 14 and 15:
Çàïðîøåí³ ñòàòò³ / G
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Îðèã³íàëüí³ ñòàòò³
Page 22 and 23:
Page 24 and 25:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Íà äîïîìîãó ïðàêòè
Page 49 and 50:
Ìàòåð³àëè äî íåôðî
Page 51 and 52:
Page 53 and 54:
Page 57 and 58:
Page 59 and 60: Ìàòåð³àëè äî íåôðî
Page 73 and 74: Ñó÷àñíà ôàðìàêîòåð
Page 77: Ñó÷àñíà ôàðìàêîòåð
Page 97 and 98: ÍàñòàíîâèGuidelines3.3.8.
Page 99 and 100: Íàñòàíîâè / GuidelinesDiag
Page 101 and 102: ÍàñòàíîâèGuidelinesDOI: ht
Page 103 and 104: Íàñòàíîâè / GuidelinesReco
Page 105 and 106: Íàñòàíîâè / Guidelines2.8.
Page 107 and 108: ÍàñòàíîâèGuidelinesDOI: ht
Page 109: Êë³í³÷íå ñïîñòåðåæ
Page 113 and 114: Äëÿ íàøèõ ïàö³ºíò³
Page 115 and 116: Îô³ö³éíà ³íôîðìàö³
show all

Журнал "Почки" том 10, №3

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?