Department of Nephrology, Suining Central Hospital, Suining, China.
Department of Hepatobiliary Surgery, Suining Central Hospital, Suining, China.
Medicine (Baltimore). 2022 Aug 19;101(33):e30066. doi: 10.1097/MD.0000000000030066.
Although coronavirus disease 2019 (COVID-19) remains a global threat, administering effective and safe vaccines is currently the most promising strategy to curb the ongoing pandemic and decrease the number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, there remains some uncertainty regarding the safety of vaccines for patients with kidney disease.
A 58-year-old man presented at our institution with gross hematuria 48 hours after receiving his first dose of the CoronaVac (Sinovac) vaccine.
Analysis of a renal biopsy sample led to the diagnosis of crescentic immunoglobulin A nephropathy (IgAN), which we considered an adverse event of receiving the CoronaVac vaccine in China.
The patient's serum creatinine and albumin levels were 1.20 mg/dL and 31.3 g/L, respectively; as such, he was administered a diuretic. His serum creatinine level had risen to 7.45 mg/dL 1 month later, and he developed high blood pressure. The patient then received conventional doses of hormone therapy but developed recurrent fever, which led to the suspicion of active tuberculosis (which he had a history of) and suspension of the hormone therapy.
The patient's renal function deteriorated further, and he ultimately underwent dialysis.
The patient's course of events of apparent IgAN exacerbation should prompt nephrologists to closely follow patients with glomerular disease after they receive a COVID-19 vaccine, especially if persistent gross hematuria occurs.
尽管 2019 年冠状病毒病（COVID-19）仍然是一个全球性威胁，但接种有效和安全的疫苗目前是遏制当前大流行和减少严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染人数的最有希望的策略。然而，对于患有肾脏疾病的患者，疫苗的安全性仍存在一些不确定性。
一名 58 岁男性在我院就诊，在接种科兴（Sinovac）疫苗第一剂后 48 小时出现肉眼血尿。
肾活检样本分析诊断为新月体性免疫球蛋白 A 肾病（IgAN），我们认为这是在中国接种科兴疫苗的不良反应。
患者的血清肌酐和白蛋白水平分别为 1.20mg/dL 和 31.3g/L，因此给予利尿剂。1 个月后，他的血清肌酐水平升高至 7.45mg/dL，且出现高血压。随后患者接受常规剂量的激素治疗，但出现反复发热，这引起了对活动性肺结核（他有既往病史）的怀疑，并暂停了激素治疗。
患者的肾功能进一步恶化，最终进行了透析。
患者的 IgAN 明显加重的病情应促使肾脏病医生在接种 COVID-19 疫苗后密切随访肾小球疾病患者，特别是如果持续出现肉眼血尿。
