Division of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China.
Clin Exp Nephrol. 2024 Jan;28(1):23-30. doi: 10.1007/s10157-023-02398-y. Epub 2023 Sep 15.
There are increasing case reports on de novo or relapsing IgA nephropathy (IgAN) following SARS-CoV-2 vaccines, although the follow-up information on renal outcomes in IgAN patients post-SARS-CoV-2 vaccination is limited. In this study, we evaluated the renal outcomes of IgAN patients following inactivated vaccines.
We investigated the change in eGFR, proteinuria and hematuria in 113 primary IgAN patients post-vaccination. Worsening proteinuria was defined as an increase in proteinuria by more than 0.5 times and proteinuria > 1 g/d. Univariate and multivariable logistic regression analysis were used to evaluate possible predictors of worsening proteinuria. We then compared the renal outcomes of vaccinated patients after 6 months with 101 unvaccinated patients who were followed during the same period.
A 2.54% (0.64, 8.61) decrease in renal function was observed in post-vaccination patients. Subgroup analysis revealed a significant decrease in eGFR in patients with 30 ≤ eGFR < 60 (mL/min/1.73 m) post second SARS-CoV-2 dose (n = 18, p = 0.01). In addition, 10 individuals displayed worsening proteinuria post-vaccination, with the proteinuria subsequently ameliorating significantly after 6-month. Multivariate analysis showed that higher eGFR levels was an independent protective factor for worsening proteinuria. The renal outcome tended towards a decrease in eGFR in vaccinated patients after 6 months follow-up, although the difference was not significant (p = 0.06).
Kidney function in IgAN patients tended to worsen after SARS-CoV-2 vaccination, particularly those with initial poor kidney function. This pattern of disease flare appears to be clinically mild, and further research is needed to determine whether the impact on kidney function is long-term.
越来越多的病例报告显示，在接种 SARS-CoV-2 疫苗后会出现新诊断或复发的 IgA 肾病（IgAN），尽管关于 IgAN 患者接种 SARS-CoV-2 疫苗后肾脏结局的随访信息有限。在这项研究中，我们评估了 IgAN 患者接种灭活疫苗后的肾脏结局。
我们调查了 113 例原发性 IgAN 患者接种疫苗后的 eGFR、蛋白尿和血尿变化。蛋白尿加重定义为蛋白尿增加超过 0.5 倍且蛋白尿>1g/d。使用单变量和多变量逻辑回归分析评估蛋白尿加重的可能预测因素。然后，我们比较了接种疫苗的患者在 6 个月后的肾脏结局与同期未接种疫苗的 101 例患者的肾脏结局。
接种疫苗后，肾功能下降了 2.54%（0.64，8.61）。亚组分析显示，在接种第二剂 SARS-CoV-2 疫苗后，eGFR 为 30≤eGFR<60（mL/min/1.73m）的患者的 eGFR 显著下降（n=18，p=0.01）。此外，有 10 人在接种疫苗后出现蛋白尿加重，6 个月后蛋白尿显著改善。多变量分析显示，较高的 eGFR 水平是蛋白尿加重的独立保护因素。在 6 个月的随访后，接种疫苗的患者的肾脏结局倾向于 eGFR 下降，尽管差异无统计学意义（p=0.06）。
在接种 SARS-CoV-2 疫苗后，IgAN 患者的肾功能趋于恶化，特别是那些初始肾功能较差的患者。这种疾病发作模式似乎是临床轻度的，需要进一步研究以确定对肾功能的影响是否是长期的。
