Clajus Christian, Spiegel Janine, Bröcker Verena, Chatzikyrkou Christos, Kielstein Jan T
Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany.
BMC Nephrol. 2009 Aug 5;10:21. doi: 10.1186/1471-2369-10-21.
The most common cause of idiopathic nephrotic syndrome in children and younger adults is the minimal change nephrotic syndrome (MCNS). In the elderly MCNS is relatively uncommon. Over the last decade some reports suggest a rare but possible association with the administration of various vaccines.
A 82-year old Caucasian female presented with pronounced nephrotic syndrome (proteinuria of 7.1 g/d, hypoproteinemia of 47 g/l). About six weeks prior to admission, she had received a combination vaccination for tetanus, diphtheria and poliomyelitis as a booster-vaccination from her general practitioner. The renal biopsy revealed typical minimal change lesions. She responded well to the initiated steroid treatment. As through physical examination as well as extensive laboratory and imaging studies did neither find any evidence for malignancies nor infections we suggest that the minimal change nephrotic syndrome in this patient might be related to the activation of the immune system triggered by the vaccination.
Our case as well as previous anecdotal reports suggests that vaccination and the resulting stimulations of the immune system might cause MCNS and other severe immune-reactions. Increased awareness in that regard might help to expand the database of those cases.
儿童和年轻成年人特发性肾病综合征最常见的病因是微小病变肾病综合征（MCNS）。在老年人中，MCNS相对不常见。在过去十年中，一些报告表明它与各种疫苗接种存在罕见但可能的关联。
一名82岁的白种女性出现明显的肾病综合征（蛋白尿7.1g/d，低蛋白血症47g/l）。入院前约六周，她从全科医生处接受了破伤风、白喉和脊髓灰质炎联合疫苗的加强接种。肾活检显示典型的微小病变。她对开始的类固醇治疗反应良好。由于体格检查以及广泛的实验室和影像学检查均未发现任何恶性肿瘤或感染的证据，我们认为该患者的微小病变肾病综合征可能与疫苗接种引发的免疫系统激活有关。
我们的病例以及之前的轶事报告表明，疫苗接种及由此产生的免疫系统刺激可能导致MCNS和其他严重的免疫反应。在这方面提高认识可能有助于扩大此类病例的数据库。
