Viral tubulointerstitial nephritis in children: A narrative review with a focus on adenovirus.

Viral infections are well-known causes of systemic illness in children, but their kidney involvement, particularly acute tubulointerstitial nephritis (TIN), remain underdiagnosed and clinically underestimated. A wide range of viruses has been implicated in pediatric TIN, including Epstein-Barr virus, cytomegalovirus, BK virus, parvovirus B19, respiratory syncytial virus, and SARS-CoV-2. Among these, adenovirus stands out for its potential to cause severe kidney injury. Delayed diagnosis remains a challenge due to nonspecific symptoms and limited use of kidney biopsy. Heightened clinical suspicion and early virologic work-up are essential to enable timely intervention and improve outcomes. This narrative review aims to raise awareness of viral-associated TIN in the pediatric population, with a specific focus on adenovirus. In addition to summarizing cases identified from the existing literature, we present two pediatric cases with biopsy-confirmed TIN: one in a kidney transplant recipient and the other in a previously healthy infant, illustrating the broad clinical spectrum of the disease.