Wu Henry H L, Kalra Philip A, Chinnadurai Rajkumar
Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
Vaccines (Basel). 2021 Oct 29;9(11):1252. doi: 10.3390/vaccines9111252.
The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination.
A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review.
Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy.
This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.
新冠病毒疫苗接种计划的推行已成为全球减少新冠病毒感染人数主要策略的一个组成部分。新冠病毒疫苗接种后出现新发和复发的肾脏组织病理学变化的情况已有报道，引发了关于是否存在因果关联的争论。这些疫苗如何实现对新冠病毒的免疫反应以及触发肾脏病理变化的机制仍未明确。我们描述了一项关于新冠病毒疫苗接种后新发和复发肾脏组织病理学变化的系统评价结果。
通过系统评价和Meta分析的首选报告项目（PRISMA）指南，对截至2021年8月31日已发表的数据进行了系统的文献检索。纳入报告新冠病毒疫苗接种后成年患者（>18岁）新发或复发肾脏组织病理学变化的研究文章进行定性评价。仅选择以英文发表的全文文章进行评价。
本系统评价的定性综合分析纳入了36篇文章中的48个病例。微小病变病（19例）是观察到的最常见病理类型，其次是IgA肾病（14例）和血管炎（10例）。其他病例包括膜性肾病复发、肾移植急性排斥反应、IgG4肾炎复发、新冠病毒疫苗接种后新发肾血栓性微血管病和硬皮病肾危象。所有纳入病例均未报告死亡情况。除1例病例外，其他患者大多康复，无需长期肾脏替代治疗。
本系统评价深入探讨了新冠病毒疫苗接种后可能出现的各种肾脏病理变化之间的关系。尽管有这些报道的病例，但新冠病毒疫苗接种带来的保护益处远大于其风险。建议考虑对接种疫苗后出现新发肾病相关症状的患者尽早进行活检以确定组织病理学情况，并对有潜在复发疾病的患者监测症状。
