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Background There have been several reports of IgA nephropathy (IgAN) patients with gross hematuria and acute deterioration of urinary findings and kidney function following SARS-CoV-2 mRNA vaccination. Recent case series studies have indicated a possible link between the status of urinary findings at the time of vaccination and the subsequent appearance of gross hematuria. In this study, we aimed to determine whether the status of pre-vaccination urinary findings was associated with post-vaccination gross hematuria in patients already diagnosed with IgAN. Methods Outpatients with IgAN who had been followed up before vaccination were included. We analyzed the association between the remission of pre-vaccination microscopic hematuria (urine sediment <5 red blood cell/high power field) or proteinuria (<0.3 g/gCr) and post-vaccination gross hematuria. Results A total of 417 Japanese patients with IgAN (median age, 51 years; 56% female; estimated glomerular filtration rate (eGFR), 58 mL/min/1.73 m2) were included. The frequency of gross hematuria following vaccination was higher in 20/123 patients (16.3%) with microscopic hematuria than in 5/294 patients (1.7%) without microscopic hematuria prior to vaccination (P <0.001). There was no association between pre-vaccination proteinuria and post-vaccination gross hematuria. After adjusting for potential confounders, such as sex (female), age (<50 years), eGFR (≥60 mL/min/1.73 m2), and histories of tonsillectomy and corticosteroid therapy, pre-vaccination microscopic hematuria was still associated with post-vaccination gross hematuria (OR 8.98, P <0.001). As the severity of pre-vaccination microscopic hematuria increased, the incidence of post-vaccination gross hematuria increased (P <0.001). Conclusions Pre-vaccination microscopic hematuria in patients with IgAN is a major predictor of post-vaccination gross hematuria, regardless of potential confounders including previous treatments for IgAN.
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Gross hematuria after upper respiratory tract infections is a well-known characteristic symptom of immunoglobulin A nephropathy (IgAN). In recent years, there have been several reports of existing or newly diagnosed patients with IgAN susceptible to gross hematuria after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. However, reports of patients with IgAN and gross hematuria after SARS-CoV-2 infection are extremely rare despite a considerable number of patients with coronavirus disease 2019 (COVID-19) who preferentially present with upper respiratory symptoms. Here, we report the cases of 5 Japanese patients with IgAN who developed gross hematuria associated with SARS-CoV-2 infection. These patients presented with fever and other COVID-19-related symptoms, followed by the appearance of gross hematuria within 2 days, which lasted for 1-7 days. Acute kidney injury occurred after gross hematuria in 1 case. In all cases, microhematuria was identified before gross hematuria associated with SARS-CoV-2 infection, and it persisted after the gross hematuria episode. Because repeated gross hematuria and persistent microhematuria may lead to irreversible kidney injury, the clinical manifestations of patients with IgAN during the COVID-19 pandemic should be carefully monitored.
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Key message NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID‐19 pneumonia 4 months ago. Capillary damage from COVID‐19 might still exist. Atypical negative pressure pulmonary edema showing a peripheral accent pattern resembling ARDS has emerged after COVID‐19 pneumonia four months ago. Capillary damage from COVID‐19 might still exist.
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NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID-19 pneumonia 4 months ago. Capillary damage from COVID-19 might still exist.
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Rituximab is an effective treatment for frequently relapsing/steroid-dependent nephrotic syndrome, but there is concern about infections caused by humoral immunodeficiency. We herein report a case of prolonged (>7 weeks) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old man with minimal-change disease treated with rituximab developed SARS-CoV-2 infection. The clinical response to remdesivir was soon transiently abolished. Treatment with casirivimab and imdevimab (REGEN-COV) monoclonal antibodies in combination with remdesivir resulted in complete clearance of the infection. The REGEN-COV antibody cocktail may improve the outcome of SARS-CoV-2 infection in patients with humoral immunodeficiency.