https://pubmed.ncbi.nlm.nih.gov/38406008/

A Case of Combination of IgA Nephropathy and Interstitial Nephritis After COVID-19 Vaccination

COVID-19ワクチン接種後にIgA腎症と間質性腎炎を併発した1例

Yuki Yoshida ¹, Kenta Torigoe ¹, Ryosuke Sakamoto ¹, Shinichi Abe ¹, Kumiko Muta ¹, Hiroshi Mukae ², Tomoya Nishino ¹

Affiliations 

• PMID: 38406008
 
• PMCID: PMC10894454
 
• DOI: 10.7759/cureus.52981

Abstract

A 66-year-old male presented with renal dysfunction. 

66歳の男性が腎機能障害を呈した。

At the time of presentation, his serum creatinine (sCr) was 2.55 mg/dL, estimated glomerular filtration rate (eGFR) was 20.93 ml/min/1.73 m², urinary red blood cell (RBC) was 30-49/high power field, and urine protein-creatinine ratio was 0.43 g/gCr. 

来院時、血清クレアチニン（sCr）は2.55mg/dL、推定糸球体濾過量（eGFR）は20.93ml/分/1.73m2、尿中赤血球（RBC）は30〜49/高出力野、尿蛋白-クレアチニン比は0.43g/gCrであった。

The patient had no urinalysis abnormalities or renal dysfunction within the year prior to presentation but had gross hematuria after the third and fourth coronavirus disease 2019 (COVID-19) vaccinations. 

患者は来院前1年以内に尿検査異常や腎機能障害はなかったが、3回目と4回目のコロナウイルス疾患2019（COVID-19）ワクチン接種後に肉眼的血尿を認めた。

Therefore, immunoglobulin A nephropathy (IgAN) was suspected and a percutaneous renal biopsy was performed. 

 そのため免疫グロブリンA腎症（IgAN）が疑われ、経皮的腎生検を施行した。

Renal pathology confirmed IgAN and interstitial nephritis and glucocorticoid therapy was initiated. 

腎病理検査でIgANと間質性腎炎が確認され、グルココルチコイド療法が開始された。

Glucocorticoids improved renal function, and microscopic hematuria resolved. 

グルココルチコイドは腎機能を改善し、顕微鏡的血尿は消失した。

Although previous reports have shown that the COVID-19 vaccine induces various renal diseases, complications associated with these two renal diseases are rare. 

これまでの報告では、COVID-19ワクチンがさまざまな腎疾患を誘発することが示されているが、これら2つの腎疾患に関連した合併症はまれである。

In this case, while IgAN was suspected based on episodes of gross hematuria after vaccination, renal biopsy confirmed it and also revealed interstitial nephritis.

この症例では、ワクチン接種後の肉眼的血尿のエピソードからIgANが疑われたが、腎生検で確認され、間質性腎炎も判明した。
 

Keywords: covid-19 vaccine; glomerular nephritis; iga nephropathy (igan); severe acute respiratory syndrome coronavirus 2; tubulointerstitial nephritis.

Copyright © 2024, Yoshida et al.

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Conflict of interest statement

利益相反声明

The authors have declared that no competing interests exist.

著者らは、競合する利害関係が存在しないことを宣言している。

 

Figures

Figure 1

Renal pathology findings of light and electron microscopy.

光学顕微鏡および電子顕微鏡による腎病理所見。

(A) Mild mesangial hypercellularity was observed in glomeruli (arrowhead) (PAS staining). (B, C) The tubulointerstitium showed inflammatory cell infiltration and tubulitis (PAS staining). (D) Electron microscopy showed electron-dense deposits in mesangial area (arrow)

(A）糸球体（矢頭）に軽度のメサンギウム細胞増多を認めた（PAS染色）。(B、C）尿細管間質に炎症性細胞浸潤と尿細管炎を認めた（PAS染色）。(D）電子顕微鏡ではメサンギウム領域に電子密度の高い沈着が認められた（矢印）。

PAS: periodic acid-Schiff

 

Figure 2

Renal pathology findings of immunofluorescence microscopy

免疫蛍光顕微鏡による腎病理所見

 IgA (3+) and C3 (2+) were predominantly positive in the mesangial area. IgM (1+) was weakly positive in the same area.

 IgA（3+）とC3（2+）はメサンギウム領域で主に陽性であった。IgM（1+）は同領域で弱陽性であった。

 

Figure 3

The clinical course of the patient　患者の臨床経過

eGFR: estimated glomerular filtration rate; HPF: high power field; U-RBC: urinary red blood cell

eGFR：推算糸球体濾過量、HPF：高出力野、U-RBC：尿中赤血球

 

Figure 4

 Immunohistochemistry of cell surface markers

 細胞表面マーカーの免疫組織化学的研究

CD3, CD4, and CD8 were predominantly positive in infiltrated inflammatory cells of the tubulointerstitium.

CD3、CD4、CD8は尿細管間質に浸潤した炎症細胞で主に陽性であった。

 

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