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IgA 肾病患者接种 COVID-19 疫苗后出现大量血尿是否与足细胞病有关?

Is Podocytopathy Associated with Gross Hematuria after COVID-19 Vaccination in Patients with Immunoglobulin A Nephropathy?

机构信息

Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan.

Department of Nephrology, Saga University Internal Medicine, Japan.

出版信息

Intern Med. 2024 Oct 15;63(20):2821-2825. doi: 10.2169/internalmedicine.3247-23. Epub 2024 Feb 26.

DOI:10.2169/internalmedicine.3247-23
PMID:38403757
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11557193/
Abstract

We experienced three cases of a fever and subsequent severe, prolonged gross hematuria after COVID-19 vaccination. A kidney biopsy revealed immunoglobulin A (IgA) nephropathy, and electron microscopy showed two types of podocytopathy (podocyte damage): loss of foot processes from the glomerular basement membrane and foot process effacement. Mesangial interposition was also present in cases 1 and 3 but not in case 2. Podocytopathy is known to be a cause of proteinuria; however, the reactions to COVID-19 vaccination described here suggest that it may also be related to hematuria in IgA nephropathy.

摘要

我们遇到了三例接种 COVID-19 疫苗后发热和随后严重、持续的肉眼血尿。肾活检显示免疫球蛋白 A(IgA)肾病,电子显微镜显示两种足细胞病(足细胞损伤):肾小球基底膜的足突从基底膜脱落和足突消失。系膜插入也存在于病例 1 和 3 中,但在病例 2 中不存在。足细胞病已知是蛋白尿的原因;然而,这里描述的 COVID-19 疫苗接种反应表明,它也可能与 IgA 肾病的血尿有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/4837bec85e93/1349-7235-63-2821-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/a4c979c583fc/1349-7235-63-2821-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/2c750368e31e/1349-7235-63-2821-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/4837bec85e93/1349-7235-63-2821-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/a4c979c583fc/1349-7235-63-2821-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/2c750368e31e/1349-7235-63-2821-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b0b/11557193/4837bec85e93/1349-7235-63-2821-g003.jpg

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本文引用的文献

1
First Diagnosis of Immunoglobulin A Nephropathy Following SARS-CoV-2 mRNA Vaccination in Japan.日本首例接种新型冠状病毒mRNA疫苗后诊断为免疫球蛋白A肾病
Kidney Int Rep. 2023 Jan;8(1):179-182. doi: 10.1016/j.ekir.2022.10.012. Epub 2022 Oct 19.
2
Sibling cases of gross hematuria and newly diagnosed IgA nephropathy following SARS-CoV-2 vaccination.SARS-CoV-2 疫苗接种后出现肉眼血尿和新诊断的 IgA 肾病的同胞病例。
BMC Nephrol. 2022 Jun 21;23(1):216. doi: 10.1186/s12882-022-02843-2.
3
COVID-19 Vaccination and Glomerulonephritis.2019冠状病毒病疫苗接种与肾小球肾炎
Kidney Int Rep. 2021 Dec;6(12):2969-2978. doi: 10.1016/j.ekir.2021.09.008. Epub 2021 Oct 6.
4
Podocytopathy in the mesangial proliferative immunoglobulin A nephropathy: new insights into the mechanisms of damage and progression.足细胞病变在系膜增生性 IgA 肾病中的作用:对损伤和进展机制的新认识。
Nephrol Dial Transplant. 2019 Aug 1;34(8):1280-1285. doi: 10.1093/ndt/gfy413.
5
Immunosuppressive Treatment in Children With IgA Nephropathy and the Clinical Value of Podocytopathic Features.IgA肾病患儿的免疫抑制治疗及足细胞病变特征的临床价值
Kidney Int Rep. 2018 Mar 29;3(4):916-925. doi: 10.1016/j.ekir.2018.03.013. eCollection 2018 Jul.
6
Understanding podocytopathy and its relevance to clinical nephrology.了解足细胞病及其与临床肾脏病学的相关性。
Indian J Nephrol. 2015 Jan-Feb;25(1):1-7. doi: 10.4103/0971-4065.134531.
7
IgA nephropathy with minimal change disease.IgA 肾病伴微小病变病。
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1033-9. doi: 10.2215/CJN.11951113. Epub 2014 Apr 10.
8
Regression of IgA nephropathy: a repeat biopsy study.IgA肾病的消退:一项重复肾活检研究。
Am J Kidney Dis. 2002 Mar;39(3):493-502. doi: 10.1053/ajkd.2002.31399.