The document presents 12 cases of renal diseases caused by various viruses. It discusses the clinical presentation and pathology of each case and identifies the virus responsible. The viruses discussed are mostly DNA and RNA viruses, including HIV, HTLV-1, parvovirus B19, hepatitis C, cytomegalovirus, BK polyomavirus, Epstein-Barr virus, human herpesvirus 8, measles, mumps, adenovirus, coxsackie B virus, and influenza A. The document also notes trends in interstitial diseases being caused by certain viruses and outlines future research using viral microarrays to identify new viral causes of renal disease.

1. Kenar Jhaveri Hofstra North Shore LIJ School of Medicine March 2011 A case based approach

4. Case 1: 40 year old male, past IV Drug abuse Image Courtesy: uncnephropathology.org

5. Labs show Crt up from 0.7 to 4.0mg/dl and protein/crt ratio 15gm Image source: flickr.com

6. Patient has night sweats, weight loss and temporal wasting. Normo-tensive on exam and no edema on exam.

9. Case 2: Same patient, only difference:- He plays cricket for the West Indies Team nationally.

11. Case 3: 54 y old male with 5 years post DDRTx( thymo, steroids +, triple drug regimen)

12. P/Crt ratio 7gm, crt slowly rising, anemia, thrombocytopenia, night sweats He does mention that the other day, his son “slapped” his cheeks. Courtesy: indianjnephrol.org 2011

13. What if I changed the patient to either a child with this picture or a Sickle Cell Patient with proteinuria?

15. Case 4: 32 y old male with subnephrotic proteinuria, crt 1.3mg/dl now to 1.6 History of HIV on HAART. History of IV Drug abuse Image Courtesy: renalfellow.blogspot.com

16. UA showed 1-2+ RBC's/hpf. Serum albumin was 3.7 g/dL and serum cholesterol 209 mg/dL. All serologies were negative or normal, But C3 and C4 are low. pmj.bmj.com

17. RF is 400( elevated), IF shows strong C3 and IgM and Moderate IgG and negative IgA Image Source: uninet.edu 60nm

22. Case 5: 76 y old male with ALL with Allogenic Stem Cell transplant develops hematuria On Day +60 Image source: tpis1.upmc.com

23. Leukopenia along with a sudden rise in crt noted from 1- 3mg/dl Image Source: emedicine.medscape.com

24. Developed blurry vision as well- Ophthamology made the diagnosis Before you! Image Source: emedicine.medscape.com

26. Case 6: 67 y old LRRTx and recent admission for rejection now comes With hematuria and AKI Image Source: NKF 2001 and renalfellow.blogspot.com

27. http://www.ndt-educational.org/

28. You look in the urine and find these! pathology2.jhu.edu

31. Case 7: 56 y old male presents with proteinuria of 2.5gm and slowly rising crt Over 2-3 weeks. He has also noticed that he has worsening neuropathy and edema Over past months flickr.com

32. On exam, he has an enlarged spleen, liver and inguinal lymph nodes and You confirm peripheral neuropathy and 2+ edema. BP is elevated at 145/90 nature.com

34. Patient has monoclonal gammopathy on labs noted on serum free light chains, Over 2 weeks, patients develops hyperpigmented skin as well. SH: patient is from sub Sahara in Africa biol4634.wordpress.com

37. Case 8: 17 y old male has a cough and soar throat. His girlfriend was sick Recently as well kidneypathology.com

38. You do a detailed HEENT exam and find this? Ig A unckidneycenter.org

39. If this was a post kidney transplant patient, this virus can also cause Lymphoma! flickr.com

41. Case 8: A 56 y old female has 13gm of proteinuria. She is a physician She had a femoral stick exposure few years prior medicinembbs.blogspot.com

42. Complements are normal. On IF, shows IgG1,2 or 3 pathguy.com

43. Her antibodies to the human phospholipase A2 receptor (PLA2R) are negative Also, her LFTs are elevated

46. Case 9: 14 y old boy presents with fever and a rash. The illness resolves But few days later, there is acute rise in crt and hematuria. gamewood.net

47. The electron microscopy showed this finding:- In idiopathic variant of this disease, it can be treated with anti complement agents www1.imperial.ac.uk

49. Case 10. What if the boy had similar findings, but had pancreatitis as well On exam you noticed parotid swelling Ig A kidneypathology.com

51. Case 11. A 45 y old male with myeloma gets an allogenic stem cell transplant 15 days following, has gross hematuria and rise in crt Virus in the bone ndtplus.oxfordjournals.org

52. This virus can also cause gastroenteritis and croup tedpella.com kidneypathology.com

54. Case 12: A 23 y old male in the CCU admitted for viral myocarditis has acute Rise in crt, and hematuria kidneypathology.com

55. Patient also develops aseptic meningitis, urine has blood, no RBCS kidneypathology.com

60. Future Directions NIH has embarked on a program to identify viral causes of unexplained renal Diseases- focus on collapsing FSGS, and Thrombotic microangiopathy Use of a customized array of 655 viruses from 135 genera to be used. Waldman M, Kopp J. Virues and Kidney disease: Beyond HIV. Semin Nephrol 2008:28:6:595-607.