Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
Taunton and Somerset NHS Foundation Trust, Musgrove Park Hospital, Musgrove Park, Taunton, TA1 5DA, UK.
BMC Nephrol. 2023 Mar 14;24(1):52. doi: 10.1186/s12882-023-03089-2.
More than 4 billion doses of the Coronavirus disease (COVID-19) vaccine have been administered worldwide but the relationship between the different vaccines and the development of renal disease is unknown. We present a case of tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine.
A previously fit and well 51-year-old female presented on 27th May 2021 with a one-month history of weight loss, fatigue, nausea, and a metallic taste. She had an acute kidney injury with a creatinine of 484 umol/L. She was on no regular medications and denied taking any over-the-counter or alternative medicines. She had received her first dose of the Oxford-AstraZeneca vaccine on 23rd March 2021 and her second dose on 20th May 2021. A renal biopsy was performed the following day. The 19 glomeruli appeared normal to light microscopy but the tubulointerstitial compartment contained a dense inflammatory infiltrate including many eosinophils. There was widespread acute tubular injury with tubulitis, but no established or longstanding atrophy. A diagnosis was made of an acute tubulointerstitial nephritis. She was commenced on oral prednisolone and her renal function improved. She did not require renal replacement therapy at any time.
To our knowledge, this was the first described case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine, although a number of cases have emerged more recently. In our case the patient was very fit and well, had no previous past medical history and had not taken any recent prescribed, over-the-counter or alternative medications. The absence of these provoking factors in our case makes the vaccine the most likely explanation for the development of tubulointerstitial nephritis although the pathophysiology behind this remains unknown. Given the unprecedented number of vaccinations being delivered around the world, nephrologists should be aware of this possible link although more research into the topic is required.
全球已接种超过 40 亿剂冠状病毒病（COVID-19）疫苗，但不同疫苗与肾脏疾病发展之间的关系尚不清楚。我们报告了一例牛津-阿斯利康 COVID-19 疫苗接种后发生的肾小管间质性肾炎。
一位 51 岁既往体健的女性于 2021 年 5 月 27 日就诊，诉有一个月的体重减轻、疲劳、恶心和金属味病史。她患有急性肾损伤，肌酐为 484 μmol/L。她未服用任何常规药物，也否认服用任何非处方药或替代药物。她于 2021 年 3 月 23 日接种了第一剂牛津-阿斯利康疫苗，于 2021 年 5 月 20 日接种了第二剂。次日进行了肾活检。19 个肾小球在光镜下表现正常，但肾小管间质区有密集的炎症浸润，包括许多嗜酸性粒细胞。广泛存在急性肾小管损伤伴肾小管炎，但没有确定或长期萎缩。诊断为急性肾小管间质性肾炎。她开始口服泼尼松龙，肾功能改善。她在任何时候都不需要肾脏替代治疗。
据我们所知，这是首例牛津-阿斯利康 COVID-19 疫苗接种后发生的急性肾小管间质性肾炎病例，尽管最近出现了多例病例。在我们的病例中，患者身体非常健康，既往无病史，也未服用任何近期处方、非处方药或替代药物。在我们的病例中没有这些诱发因素，因此疫苗最有可能是导致肾小管间质性肾炎的原因，尽管其发病机制尚不清楚。鉴于全球正在进行前所未有的疫苗接种，肾脏病学家应该意识到这一可能的联系，尽管需要对这一主题进行更多的研究。
