Department of Pediatrics, Musashino Red Cross Hospital, 1-26-1, Kyonan-cho, Musashino-shi, Tokyo, 180-8610, Japan.
Department of Pediatrics, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, Japan.
CEN Case Rep. 2022 Aug;11(3):376-379. doi: 10.1007/s13730-021-00679-7. Epub 2022 Feb 3.
There has been growing interest in reported cases of IgA nephropathy (IgAN) flare-up following administration of the coronavirus disease 2019 (COVID-19) vaccine. Our patient is a previously healthy 17-year-old girl who presented with a 10-year history of microscopic hematuria. Because there were no abnormal findings in blood examination or ultrasonography, we followed her up twice per year as asymptomatic hematuria. Although she never developed gross hematuria when she had upper respiratory infections or received an influenza vaccine, she presented with gross hematuria and proteinuria within a few days after receiving the first dose of the Pfizer vaccine. We performed renal biopsy 2 weeks after the first vaccination. It revealed minor glomerular abnormalities with diffuse mesangial IgA deposits, and we diagnosed her with mild IgAN. Gross hematuria was detected after both the first and second doses, although it changed to microscopic hematuria within 1 week. Additionally, her proteinuria resolved spontaneously approximately 10 days after the second dose of the vaccine. Therefore, we opted to observe her without administering medication. The causation between COVID-19 vaccination and IgAN flare-up remains unclear. Several reports showed IgAN patients presenting gross hematuria following the second dose of the Pfizer or Moderna vaccines. However, our patient developed gross hematuria and proteinuria even after the first dose and without known severe acute respiratory syndrome coronavirus 2 exposure. Nephrologists should inform both patients with IgAN and those with asymptomatic hematuria that this side effect can occur even after the first vaccination.
越来越多的人关注到 COVID-19 疫苗接种后 IgA 肾病（IgAN）发作的报道案例。我们的患者是一位既往健康的 17 岁女孩，她有 10 年镜下血尿病史。由于血液检查和超声检查均无异常发现，我们每年对她随访两次，作为无症状血尿患者。虽然她在上呼吸道感染或接种流感疫苗时从未出现过肉眼血尿，但在接种第一剂辉瑞疫苗后几天内出现了肉眼血尿和蛋白尿。我们在第一次接种疫苗后 2 周进行了肾活检。结果显示肾小球轻微异常，弥漫性系膜 IgA 沉积，我们诊断为轻度 IgAN。第一次和第二次接种后均出现肉眼血尿，但在 1 周内转变为镜下血尿。此外，她的蛋白尿在第二次接种疫苗后约 10 天内自发缓解。因此，我们选择不给予药物治疗，观察病情。COVID-19 疫苗接种与 IgAN 发作之间的因果关系仍不清楚。有几份报告显示，IgAN 患者在接种辉瑞或 Moderna 疫苗第二剂后出现肉眼血尿。然而，我们的患者在接种第一剂后就出现了肉眼血尿和蛋白尿，且无已知的严重急性呼吸综合征冠状病毒 2 暴露。肾脏病医生应该告知 IgAN 患者和无症状血尿患者，即使在第一次接种疫苗后也可能会出现这种副作用。
