Varicella zoster: A Rare Cause of Membranoproliferative Glomerulonephritis

Introduction: A rare association of Varicella Zoster (VZV) with renal disease was first discovered in 1884 by Henoch1. There is scarce literature on the evidence of glomerulonephritis following the incidence of VZV. We are presenting a case of a 72-year-old man who was diagnosed of membranoproliferative glomerulonephritis (MPGN) post shingles. Case Description: A 72-year-old male with a past medical history of hypertension presented to primary care with profound anasarca and uncontrolled hypertension. Two months ago, he experienced shingles and responded well to antiviral therapy and prednisone. His labs were significant for spot protein/creatinine ratio of 11.35 g/dL and serum creatinine increase from 0.9 mg/dL at baseline to 1.16 mg/dL. Serological work up was revealing for low C3 level 78 mg/dL only. Subsequently after nephrology consultation, he underwent renal biopsy which revealed membranoproliferative glomerulonephritis with 3+ IgM and C3 deposition on immunofluorescence. He was started on weight-based 1 mg/kg of oral prednisone daily followed by steroid taper over a course of three months. Subsequently, his proteinuria reduced to 7.62 g/day whilst on treatment and improvement of anasarca and hypertension. Discussion: VZV associated with nephritis is uncommon and was proven with only 3 (0.1%) out of 2534 developing clinical nephritis in a 1935 study2. Molecular pathologic method (in situ hybridization) verified VZV’s growth and reproduction in kidneys causing glomerulonephritis3. The mechanism of VZV induced MPGN could be direct or immune mediated1. Membranoproliferative glomerulonephritis shows a pattern of injury with distinctive mesangial cellularity and glomerular capillary walls thickening due to subendothelial deposition of complement factors like strong C3 deposition or IgM immune complexes which was noticed in our patient6-8. Literature shows that these results are suggestive of immune complex mediated glomerulonephritis9,10. Proteinuria occurring in patients post varicella infection should caution clinicians to check for the possible diagnosis of membranoproliferative glomerulonephritis