背景:已在接种SARS-CoV-2疫苗后的患者中记录了复发或新发IgA肾病(IgAN);然而,据报道,仅有一名成年患者在2019年冠状病毒疾病期间已有IgAN恶化(COVID-19).
方法:我们介绍了第一例经活检证实的IgAN和遗传证实的Alport综合征的儿科病例,与COVID-19相关的IgAN恶化后发展为终末期肾病。患者感染前的基础血清肌酐为0.7-0.9mg/dL。他没有接种过COVID-19疫苗。他因水肿入院,高血压,血清肌酐升高4.7mg/dL,和大量蛋白尿。入院前三个月,他因COVID-19和血清肌酐升高(1.9mg/dL)被送往另一家医院,但当时没有进行活检。肾活检显示IgAN有50%的纤维细胞新月体,肾小球硬化,肾小管萎缩,和间质纤维化。他的血清肌酐即使在五次脉冲类固醇给药后也没有下降,开始血液透析.
结论:结论:COVID-19可能构成先前存在的肾小球疾病恶化的高风险。因此,有必要在COVID-19期间和之后密切监测潜在肾小球肾炎患者的肾功能,如果血清肌酐未恢复至基线水平,则考虑早期活检。此外,本病例报告强调了IgAN和Alport综合征并存的临床重要性.
Relapses or new-onset IgA nephropathy (IgAN) have been documented in patients after vaccination against SARS-CoV-2; however, only one adult patient has been reported in whom pre-existing IgAN worsened during coronavirus disease 2019 (COVID-19).
We present the first pediatric
case with biopsy-proven IgAN and genetically confirmed Alport syndrome, who developed end-stage kidney disease after an exacerbation of IgAN associated with COVID-19. The patient`s basal serum creatinine was 0.7-0.9 mg/dL before infection. He had not been vaccinated against COVID-19. He was admitted to the hospital with edema, hypertension, an elevated serum creatinine of 4.7 mg/ dL, and massive proteinuria. Three months before admission, he had been admitted to another hospital with COVID -19 and an elevated serum creatinine (1.9 mg/dL), but no biopsy had been performed at that time. The kidney biopsy revealed IgAN with 50% fibrocellular crescents with sclerosed glomeruli, tubular atrophy, and interstitial fibrosis. His serum creatinine did not decrease even after five administrations of pulse steroids, and hemodialysis was initiated.
In conclusion, COVID -19 may pose a high risk for exacerbation of pre-existing glomerular disease. It is therefore necessary to closely monitor the kidney function of patients with underlying glomerulonephritis during and after COVID-19 and consider an early biopsy if serum creatinine does not return to baseline levels. In addition, this
case report highlights the clinical importance of the co-occurence of IgAN and Alport syndrome.