Mechanics Signs and Symptoms exhibited by the patient.
Main Diagnosis Secondary Diagnosis
LEGENDS:
Confirmatory Diagnostic results
close contact with an individual
infected with EBV:
• Kissing
• Sharing drinks and food
• Sharing the same utensils or
toothbrush
• Having contact with toys that
EBV+ children drooled on
Immune response: B lymphocytes
engages with the virus.
11% atypical
lymphocytes ELEVATED
Mature CD8+ T cells
responds.
• right kidney axes:
82 mm (8.2 cm) BIG
• left kidney long axes:
83 mm (8.3 cm) BIG
Swelling of the kidneys
• renal biopsy material
showed: intense and mixed
tubulointerstitial
inflammatory infiltration rich
with T cells and histiocytes.
Predisposing Factors
EBV transferred through saliva.
EBV is exposed to the oral cavity.
EBV then replicates
in the nasopharynx.
Inflammation of the nasopharynx
EBV infects B lymphocytes.
Development of EBV
infected B lymphocytes
Development of EBV
infected T lymphocytes
EBV infected B and T lymphocytes then
spreads toward the entire reticular
endothelial system (i.e liver, spleen)
EBV infected T cells infiltrates into the
renal interstitium of both kidneys.
Presence of EBV infected T cells promotes the
secretion of inflammatory cytokines and histiocytes.
Inflammatory cytokines
compromise epithelial barriers.
Promotes tubular epithelial atypia.
Tubulointerstitial Nephritis (TIN)
Acute Kidney Injury
Epstein-Barr Viral Infection
• Presence of EBV VCA IgG and IgM
antibodies
• Presence of atypical lymphocytes
• Pharyngitis
• Bilateral orbital edema
• Inflammation of liver, spleen, and
or kidneys
• Petechial rashes
• hyperemia of pharynx
• fever
• WBC was 17,060/mm3
SLIGHTLY ELEVATED
• Free collections: perihepatic,
peri splenic
• mild elevation of
transaminases (aspartate
aminotransferase: 170 U/L
and alanine
aminotransferase: 79 U/L)
• albumin: 2.95 g/dL =
proteinuria
• 7 leucocytes in urine =
infection
• 2 erythrocytes in urine =
hematuria
• potassium: 7.09 mEq/L
ELEVATED
• bicarbonate: 11.5 mEq/L LOW
• urea: 181 mg/dL VERY
ELEVATED
• creatinine: 4.1 mg/dL
ELAVATED
• calcium: 7.3 mg/dL ELAVATED
• Both kidneys had grades 1-2
parenchymal
hyperechogenicity
•
Reductions in glomerular
filtration rate (GFR)
Oligoanuria
• presence of peripheral
atypical lymphocytosis and
positive serological tests for
EBV
• bilateral upper lid edema
• some petechial rashes on
lower limbs
• maculopapular rash that blanches under pressure
• low urine output
• bilateral orbital edema