Department of Nephrology and Hypertension, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan.
Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Clin Exp Nephrol. 2024 Nov;28(11):1168-1177. doi: 10.1007/s10157-024-02521-7. Epub 2024 Jun 15.
Although vaccination has been reported to reduce the morbidity and severity of COVID-19 infection in patients with kidney disease, gross hematuria is frequently reported following vaccination in patients with IgA nephropathy. We investigated the frequency of gross hematuria following COVID-19 vaccination and its effect on renal function in IgA nephropathy patients.
Adverse reactions after two or more COVID-19 vaccine doses were investigated in 295 IgA nephropathy patients attending Osaka Cty general hospital from September 2021 to November 2022. We compared differences in background characteristics and other adverse reactions between groups with and without gross hematuria after vaccination, and examined changes in renal function and proteinuria.
Twenty-eight patients (9.5%) had gross hematuria. The median age of patients with and without gross hematuria was 44 (29-48) and 49 (42-61) years, respectively, indicating a significant difference. The percentage of patients with microscopic hematuria before vaccination differed significantly between those with (65.2%) and without (32%) gross hematuria. Adverse reactions, such as fever, chills, headache and arthralgia, were more frequent in patients with gross hematuria. There was no difference in renal functional decline after approximately 1 year between patients with and without gross hematuria. We also found no significant changes in estimated glomerular filtration rate or proteinuria before and after vaccination in the gross hematuria group. However, some patients clearly had worsening of renal function.
While COVID-19 vaccination is beneficial, care is required since it might adversely affect renal function in some patients.
尽管疫苗接种已被报道可降低肾病患者 COVID-19 感染的发病率和严重程度，但在 IgA 肾病患者中，疫苗接种后常出现肉眼血尿。我们研究了 COVID-19 疫苗接种后肉眼血尿的频率及其对 IgA 肾病患者肾功能的影响。
我们调查了 2021 年 9 月至 2022 年 11 月期间在大阪市立综合医院就诊的 295 例 IgA 肾病患者接种两剂或两剂以上 COVID-19 疫苗后的不良反应。我们比较了接种后有和无肉眼血尿组之间的背景特征和其他不良反应的差异，并检查了肾功能和蛋白尿的变化。
28 例（9.5%）患者出现肉眼血尿。有和无肉眼血尿患者的中位年龄分别为 44（29-48）岁和 49（42-61）岁，差异有统计学意义。接种前有镜下血尿的患者比例在有（65.2%）和无（32%）肉眼血尿的患者之间差异有统计学意义。有肉眼血尿的患者更常出现发热、寒战、头痛和关节痛等不良反应。大约 1 年后，有和无肉眼血尿的患者的肾功能下降无差异。我们还发现，在肉眼血尿组中，接种前后肾小球滤过率估计值或蛋白尿均无明显变化。然而，一些患者的肾功能确实恶化了。
虽然 COVID-19 疫苗接种有益，但需要谨慎，因为它可能会对某些患者的肾功能产生不利影响。
