PDF(Pubmed)
Abstract：
Although mRNA vaccines for COVID-19 are highly beneficial and are recommended for patients with kidney disease, adverse reactions in some patients after vaccination have been problematic. Various vasculitis and renal disorders have been reported after vaccination; however, a causal relationship has not yet been identified. In this report, we describe a case of rapidly progressive glomerulonephritis that developed after SARS-CoV-2 vaccination, in which both anti-glomerular basement membrane (anti-GBM) and myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) were present. The patient\'s renal biopsy showed that of the 48 glomeruli in total, four showed global sclerosis and none showed segmental sclerosis. The biopsy showed 11 cellular glomerular crescents and 5 fibrocellular glomerular crescents. Renal function improved with steroids, rituximab, and plasma exchange. Approximately 9 months later, MPO-ANCA was again elevated, and the pulmonary lesions worsened, again requiring multidisciplinary treatment. This case suggests that caution should be exercised in the development of double-positive disease after vaccination, and that long-term observation may be necessary because of the possibility of relapse.
摘要：
尽管COVID-19的mRNA疫苗非常有益，推荐用于肾病患者，一些患者接种疫苗后的不良反应一直存在问题。疫苗接种后，已经报道了各种血管炎和肾脏疾病；然而，因果关系尚未确定。在这份报告中,我们描述了在SARS-CoV-2疫苗接种后发展的快速进展性肾小球肾炎的病例，其中同时存在抗肾小球基底膜（抗GBM）和髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）。患者的肾活检显示总共48个肾小球，4例表现为全球性硬化症,无1例表现为节段性硬化症.活检显示11个细胞肾小球新月和5个纤维细胞肾小球新月。用类固醇改善肾功能，利妥昔单抗,和血浆置换。大约9个月后,MPO-ANCA再次升高,肺部病变恶化，再次需要多学科治疗。这种情况表明，在接种疫苗后双阳性疾病的发展中应谨慎行事，由于复发的可能性，长期观察可能是必要的。
