Acute kidney injury (AKI) and nephrotic syndrome (NS) are uncommon manifestations of Epstein-Barr virus (EBV) mononucleosis . We report a 4-year-old boy with Infectious mononucleosis (IM) who presented with dialysis-requiring AKI and NS . Renal biopsy showed severe acute tubular necrosis, mild chronic interstitial nephritis and focal podocyte foot processes effacement . EBV early RNA was not detected in the renal tissue . However, immunophenotyping of peripheral lymphocytes showed increased cytotoxic T cell activity and increased memory B cells . Treatment with steroid led to rapid resolution of NS within 3 weeks . Renal function stabilised . EBV viral capsid antigen (VCA) IgM remained elevated until 4 months before starting to decline when VCA IgG and nuclear antigen started appearing . B lymphocytes are the predominant target cells in EBV infection and additionally may also act as antigen presenting cells to T lymphocytes, thereby eliciting the strong immune response and leading to podocyte and tubulointerstitial injury.