Arakawa Haruna, Yokoyama Shohei, Ohira Takehiro, Kang Dedong, Honda Kazuho, Ueda Yoshihiko, Tojo Akihiro
Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan.
Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan.
Vaccines (Basel). 2022 Sep 1;10(9):1442. doi: 10.3390/vaccines10091442.
A 16-year-old girl with no history of renal disease had a fever of 38 °C after her second HPV vaccination and was identified as positive for proteinuria. As she maintained urinary protein of 3.10 g/gCr and 5-9 urinary red blood cells/HPF, a renal biopsy was performed and small spikes on PAM staining with the granular deposition of IgG1++ and IgG3+ on the glomerular capillary wall were discovered by immunofluorescence, although PLA2R immunostaining was negative. Analysis by electron microscope showed electron density deposition in the form of fine particles under the epithelium. The diagnosis was secondary membranous nephropathy stage II. Immunostaining with the anti-p16 INK4a antibody was positive for glomerular cells, and Western blot analysis of urinary protein showed a positive band for p16 INK4a. However, laser-microdissection mass spectrometry analysis of a paraffin section of glomeruli failed to detect HPV proteins. It is possible that the patient was already infected with HPV and administration of the HPV vaccine may have caused secondary membranous nephropathy.
一名无肾脏疾病史的16岁女孩在第二次接种人乳头瘤病毒（HPV）疫苗后出现38°C发热，并被确诊为蛋白尿阳性。由于她的尿蛋白维持在3.10 g/gCr，每高倍视野有5 - 9个尿红细胞，遂进行了肾活检。免疫荧光检查发现，过碘酸-雪夫（PAM）染色有小钉突，肾小球毛细血管壁上有IgG1++和IgG3+颗粒状沉积，尽管血小板膜糖蛋白受体2（PLA2R）免疫染色为阴性。电子显微镜分析显示上皮下有细颗粒状电子密度沉积。诊断为II期继发性膜性肾病。抗p16 INK4a抗体免疫染色显示肾小球细胞呈阳性，尿蛋白的蛋白质印迹分析显示p16 INK4a有阳性条带。然而，肾小球石蜡切片的激光显微切割质谱分析未能检测到HPV蛋白。该患者可能已感染HPV，接种HPV疫苗可能导致了继发性膜性肾病。
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