Evaluation of herpesvirus members on hospital admission in patients with systemic lupus erythematous shows higher frequency of Epstein-Barr virus and its associated renal dysfunction

• Published in: Brazilian Journal of Nephrology Vol. 44; no. 4; pp. 490 - 497
• Main Authors: Lino, Katia, Alves, Lilian Santos, Trizzotti, Natalia, Raposo, Jessica Vasques, Souza, Cintia Fernandes, Silva, Andrea Alice da, Paula, Vanessa Salete de, Almeida, Jorge Reis
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Nefrologia 01-10-2022
• Subjects: Adult; CMV; Coinfection - complications; Creatinine; Cytomegalovirus Infections; Epstein-Barr Virus Infections - complications; Female; Herpesviridae; Herpesviridae Infections - complications; Herpesvirus 4; Herpesvirus 4, Human; Hospitals; HSV-1; Human; Humans; Kidney; Kidney Diseases - complications; Lupus Erythematosus; Lupus Erythematosus, Systemic - complications; Lupus Nephritis; Male; Middle Aged; Original; Systemic; Urea; Young Adult
• ISSN: 0101-2800; 2175-8239
• DOI: 10.1590/2175-8239-JBN-2021-0184

Members of the Herpesviridae family have been described in patients with systemic lupus erythematous (SLE), but the clinical impact on renal function is not well known.
HSV1, HSV2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8 were evaluated by molecular biology on admission in blood samples from 40 consecutive SLE patients hospitalized for lupus activity.
Patients were 90.0% female, 77.5% non-white, with average age of 32.7 ± 13.6 years. We found positivity for EBV (65.0%), CMV (30.0%), HSV-1 (30.0%), HHV-6 (12.5%), and HHV-7 (7.5%). For all viruses, age, SLEDAI, hematological tests, ferritin, LDH, C-reactive protein, and erythrocyte sedimentation rate (ESR) were not significant. However, EBV positivity was a significant factor for higher serum creatinine (3.0 ± 2.8 vs. 0.9 ± 0.8; P = 0.001) and urea (86 ± 51 vs. 50 ± 46; P = 0.03). Moreover, positive cases for EBV only or with combined co-infections (66.7%-CMV; 58.3%-HSV-1) or negative for EBV only were evaluated by Kruskal-Wallis test again showed statistical significance for serum creatinine and urea (both P ≤ 0.01), with posttest also showing statistical differences for renal dysfunction and EBV presence (alone or in combined co-infections). The presence of EBV viral load was also significant for nephrotic-range proteinuria, renal flare, and the need for hemodialysis.
Members of the Herpeviridae family (mainly EBV, HSV-1 and CMV) are common on hospital admission of SLE patients, reaching 65% for EBV, which seems to be associated with renal dysfunction and could reflect a previous association or overlapping disease, which is not well understood.