ABSTRACT
Introduction: There have been some reports on flare-ups of kidney diseases following COVID-19 vaccines such as IgA nephropathy and minimal change disease. However, there have been few reports on those of IgA vasculitis following the vaccines yet. We report a case of IgA vasculitis with a flare-up of gross hematuria and lower-limb purpura following Moderna COVID-19 vaccines. Method(s): The patient is a 16-year-old female with no previous history of abnormal results of urinalyses before April in 2021. She had developed microscopic hematuria, proteinuria and purpura on both of her lower limbs that emerged and then disappeared repeatedly since then. She received Moderna COVID-19 vaccines in August and September in 2021, both of which were followed by gross hematuria lasting for around 10 days. The lower-limb purpura reemerged at the same time as the hematuria. Microscopic hematuria of around 30-49 RBC/HPF, glomerular hematuria of moderate degree and urine protein-to-creatinine ratio (UPCR) of around 0.8 g/gCr had continuously been detected. Skin and kidney biopsies were performed in December in 2021 and in February in 2022 respectively. Result(s): The skin tissue showed formation of leukocytoclastic vasculitis, and the kidney tissue showed that of cellular and fibrocellular crescents and endocapillary hypercellularity. Immunofluorescence staining of both tissues showed deposition of galactose-deficient IgA1(Gd-IgA1) and C3, and she was diagnosed as IgA vasculitis. She received steroid pulse therapy followed by tonsillectomy. The lower-limb purpura has disappeared after she received three courses of the steroid pulse therapy, but microscopic hematuria and UPCR of around 0.8 g/gCr have still continued. Conclusion(s): IgA vasculitis is leukocytoclastic vasculitis characterized by deposition of Gd-IgA1 on microvessel walls in skin and on glomerular capillaries in kidneys. The detailed mechanism of IgA vasculitis has not been fully elucidated yet. Gross hematuria following an upper respiratory infection is considered as a characteristic clinical symptom of IgA vasculitis as well as IgA nephropathy. Post-vaccination gross hematuria of patients with IgA nephropathy has been reported, and it is believed that innate immunity is related to its mechanism. Moderna COVID-19 vaccines, which the patient received, are mRNA vaccines. We estimate that exposure to the mRNA vaccine triggered excess glomerular deposition of Gd-IgA1-containing immune complexes and subsequent gross hematuria by overactivation of innate immunity such as Toll-like receptors that detect RNA. This case suggests that such immune activation by a mRNA vaccine might be related not only to the mechanism of IgA nephropathy but also to that of IgA vasculitis. No conflict of interestCopyright © 2023
ABSTRACT
Background: With Thailand regarded as food secure for nearly a decade, at-risk groups including migrant workers still face food insecurity and have higher risk of acquiring HIV infection. People living with HIV and facing food insecurity have been documented to have higher risk of poor health and HIV treatment outcomes, notably altered risk behaviours and decreased adherence to antiretroviral therapy (ART). However, research on direct links between food insecurity and treatment outcomes such as viral suppression is scarce. The aim of this study was to investigate how food insecurity are associated with income, viral suppression, ART treatment and ART adherence in Burmese migrant workers living with HIV in Chiang Mai province of northern Thailand. Methods: Data collected through face-to-face survey was combined with routine laboratory tests in a cohort of 316 migrants (113/203 M/F) living with HIV. 11 treatment centers for HIV in rural and urban Chiang Mai gathered data on ART use and adherence, physical and mental health, sexual behaviour, socio-demographics and food security (Household Food Insecurity Access Scale (HFIAS-III)). Using a step-down multivariate logistic regression, we calculated odds ratios (OR) and 95% confidence intervals (CI), adjusting for confounders, including ART regimen. Results: In this cross-sectional study, 48.7% (n=162) of migrant workers living with HIV reported food insecurity, and 14.2% (n=45) fulfilled criteria for severe food insecurity. Most respondents were ART-adherent 96.8% (n=305), and virally suppressed 93.5% (n=290), with 4.1% (n=13) expressing symptoms of clinical depression. In adjusted analysis, food insecurity was associated with lack of viral suppression [OR=4.13, CI=1.22-14.00] and perceived poverty/lack of income [OR=5.96, CI=2.58-13.76]. Conclusion: Burmese migrant workers living with HIV in Chiang Mai report high adherence to ART and are mostly virally suppressed. Food insecurity is here linked to viremia and poverty or lack of income, suggesting that a subset of migrants face multiple burdens that increase their likelihood of becoming viremic. With food insecurity and poverty rising as a result of the COVID-19 pandemic this may end up negatively impacting HIV treatment outcomes.
ABSTRACT
Background: Novel coronavirus, severe acute syndrome coronavirus 2 (SARSCoV- 2), has rapidly spread all over the world. SARS-CoV-2 enters host target via angiotensin-converting enzyme-2 which are ubiquitously expressed in many organs including proximal tubules in kidney. Indeed, autopsy cases with coronavirus disease-2019 (COVID-19) revealed the existence of coronavirus particles in the renal tubular epithelium. Several reports have shown COVID-19-associated acute kidney injury (AKI), however involvements of SARS-CoV2 in tubular injury has not been fully understood. Here, we evaluated tubular injury in patients with severe and non-severe COVID19. Methods: We investigated the relationship between urinary levels of tubule markers (NAG, β2-MG, α1MG, and L-FABP) and laboratory markers in 17 COVID-19 patients without chronic kidney disease on admission. We also analyzed the relationship between the laboratory markers and respiratory status in severe (n=7) or non-severe (n=10) COVID-19 patients which were defined by requirements of supplemental oxygen. Results: Although only 2 patients developed AKI in severe cases, serum Interleukin-6 (IL-6) level significantly increased in all of severe patients and correlated with levels of proteinuria (R2=0.37, p=0.01), NAG (R2=0.41, p=0.006), α1MG (R2=0.47, p=0.007), L-FABP (R2=0.57, p=0.001) on admission. In addition, severe patients had significantly higher levels of proteinuria (severe: 0.67 vs non-severe: 0.14g/gCr), NAG (33.3 vs 10.1U/L), β2MG (17134.4 vs 1168.5μg/L), α1MG (63.6 vs 12.4mg/L), L-FABP (57.9 vs 7.5μg/gCr) as compared to non-severe cases. Proteinuria and elevated tubular markers were observed only in 2 and 6 cases respectively in non-severe patients, despite those were found in all severe cases. Conclusions: We found that acute tubular injury was associated with the severity of COVID-19 infection. Since the pathophysiological hallmark of COVID-19 is severe systemic inflammation, it remains obscure whether progressive damage of tubules in SARS-CoV-2 is the result of direct viral infection, ischemic injury, or exposure of any humoral factors. Further large scaled studies focusing on tubular damage should be needed to elucidate underlying mechanisms of renal complication in COVID-19 infection.