ESPN 51th Annual Meeting

ESPN 2018


 
Renal involvement in Parvovirus B19 (PVB19) vasculitis: different courses and therapeutic approaches of three pediatric cases
MATTIA PAROLIN 1 DAVIDE MENEGHESSO 1 ENRICO VIDAL 1 GIULIA FREGONESE 1 ELISA BENETTI 1 GERMANA LONGO 1 LUISA MURER 1

1- PEDIATRIC NEPHROLOGY DIALYSIS AND TRANSPLANTATION UNIT, DEPARTMENT FOR WOMAN AND CHILD HEALTH, UNIVERSITY OF PADUA
 
Introduction:

 

PVB19 is a member of Erythroparvoviruses genera.This virus is able to infect mainly human erythroid progenitor cells,through the bind with its specific receptor called globoside.Although the globoside concentration is high in red blood cells and their precursors we find it,to a lesser extend,on other cell types such as glomerular endothelial cells.Through this bind,PVB19 can lead to a direct glomerular damage,via viral cytotoxicity, with TNF-alpha involvement,cellular apoptosis and then increased in glomerular permeability.By the other hand the PVB19-mediated glomerular injury can be consequence of the humoral immunity involvement with deposition of immunocomplexes in glomerular endothelial cells.

Material and methods:

We describe 3 pediatric cases of systemic vasculistis with renal involvment and PVB19 detection in blood and renal tissue by PCR.

Results:

 

Case1:M,4y,onset with Henoch-Schonlein purpura(HSP),nephrotic range proteinuria (7g/L)and histological finding of mesangial-proliferative glomerulonephritis(GN).The therapy was 3 daily doses of immunoglobulines(Ig)400mg/Kg repeated after one week with subsequent PVB19 negativity and reduction in proteinuria until the normal range in two months.

Case2:M,5y,onset with HSP,nephrotic range proteinuria(9g/L)and kidney biopsy with mesangial GN and crescents.After a first line therapy with Ig and steroid,due to lack in response,we performed plasmaexchange and cyclophosphamide without results.Only after administration of Ab-TNFα(infliximab)we found a reduction in proteinuria <1g/L and viral absence.

Case3:M,5y,onset with ankles arthritis, melena and nephrotic range proteinuria(3g/L). Biopsy showed segmental mesangial proliferation with endocapillary inflammatory cells infiltration. Administration of steroid and Ig(400mg/kg)for 5 days was performed with normalization in proteinuria despite the virus persistence.

Conclusions:

 

PVB19 can be involved in vascultic diseases and the kidney can be a target.The healing is linked both to the underlying pathogenetic mechanism and the resolution of viral infection as well as,of course,to therapy.Ig infusion could be performed as a first line therapy,but,regarding the TNFα damage pathway,the employment of infliximab could be considered as a rescue therapy.