Parvovirus B19 infection and kidney injury: report of 4 cases and analysis of immunization and viremia in an adult cohort of 100 patients undergoing a kidney biopsy

Maëlis Kauffmann,Olivier Moranne,Yannick Knefati,Mickaël Bobot,Noémie Jourde-Chiche,Stéphane Burtey,Christine Zandotti,Laurent Daniel,Julia Torrents

doi:10.1186/s12882-020-01911-9

Abstract

BackgroundThe seroprevalence of human Parvovirus B19 (PVB19) is 70–85% in adults worldwide. PVB19 is the etiologic agent of the fifth disease, is a cause of aplastic anemia, and can be associated with kidney injury. We aimed to describe the cases of 4 patients with kidney injury related to PVB19 primary infection, and to evaluate the seroprevalence of PVB19 and the incidence of PVB19 primary infection in patients undergoing a native kidney biopsy.MethodsCases of PVB19 infection with kidney injury were reviewed from the archives of the department of Nephrology. A systematic screening of anti-PVB19 IgG and IgM antibodies and viral DNA was performed in sera from 100 consecutive patients with a kidney biopsy in 2017–2018.ResultsThe 4 patients with PVB19 infection-associated kidney disease displayed: one lupus-like glomerulonephritis (GN) without lupus auto-antibodies, one minimal change disease with tubular necrosis, one secondary hemolytic and uremic syndrome and one membrano-proliferative GN. In the 100 patients biopsied, 67 had elevated anti-PVB19 IgG, among whom 8 had elevated IgM, without circulating viral DNA, without any particular renal pathological pattern. One additional patient showed a seroconversion at the time of kidney biopsy, which revealed a class V lupus nephritis.ConclusionPVB19 primary infection can be associated with different kidney diseases. The seroprevalence of PVB19 among patients with a kidney biopsy is similar to the overall population, and primary infection is rarely documented (1%) after systematic screening. Whether PV19 is nephrotoxic, or triggers renal endothelial injury and immune activation, remains to be elucidated.

Highlights

The seroprevalence of human Parvovirus B19 (PVB19) is 70–85% in adults worldwide
Four cases of PVB19-associated kidney diseases Case report n°1 (2018): lupus-like glomerulonephritis (Fig. 1a) A 42-year-old women was admitted to the Nephrology department in 2018 for a weight gain of 12 kg over a week, with exertional dyspnea
Case report n°2 (2015): minimal change disease (MCD) and acute tubular necrosis (Fig. 1b) A 42-year-old women was admitted to the Nephrology department in 2015 for an acute nephritic syndrome

Summary

Introduction

The seroprevalence of human Parvovirus B19 (PVB19) is 70–85% in adults worldwide. PVB19 is the etiologic agent of the fifth disease, is a cause of aplastic anemia, and can be associated with kidney injury. Human parvovirus B19 (PVB19) is a ubiquitous small ssDNA virus, known as the etiologic agent of the fifth disease. Most adults worldwide show evidence of past infection (between 70 and 85%), but a primary infection can occur lately [1]. PVB19 infection is a matter of concern mainly in kidney transplant recipients, as a cause of aplastic anemia and pure red cell aplasia. The incidence of PVB19 infection after kidney transplantation either as a primary infection or a reactivation, varies between 2 and 30% [3]. Extra-hematological and extra-renal signs can vary from mild or moderate (rash, symmetric arthralgia or arthritis) to severe manifestations (myocarditis, pericarditis, cryoglobulinemic vasculitis, lymphoproliferation), depending on the age, comorbidity, and immunological status of the host [9]

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