Viral Infections and the Kidney

Abstract

Viral infections are associated with a number of renal diseases in children resulting in significant morbidity and mortality worldwide. The role of viral infections in the pathogenesis of kidney disease has been largely based on clinical and histologic kidney findings in temporal association with a systemic viral infection and the demonstration of kidney cells infected with viral particles. Viral infections associated with productive viral replication in the kidney of immunocompromised hosts are of particular concern for children. Here, we will discuss the epidemiology, pathogenesis, outcomes, and treatment of the most relevant kidney diseases associated with viral infections in children, excluding those occurring in kidney transplant recipients, which are discussed elsewhere in this textbook (see chap. 84, Renal transplantation: infectious complications). Well-defined associations between a viral infection and kidney disease have been made for the hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV-1), hantaviruses, and the new coronavirus SARS-CoV-2. In children with immunodeficiency states, herpes viruses, polyomavirus, and adenovirus have been recognized to induce kidney diseases. The roles of other viruses in the pathogenesis of kidney diseases are not clearly defined and remain speculative. With increasing application of molecular techniques, the understanding of the role of viruses in the pathogenesis of kidney diseases is expected to increase. In addition, more specific antiviral treatments and vaccines are currently under development and are expected to improve the outcome of viral-mediated kidney diseases in children.