Daigo Kobayashi, Jun Yoshino, Maki Hanada, Masafumi Ohba, Tomohiro Oka, Kenichi Itoga, Daisuke Niino, Takeshi Kanda
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引用次数: 0
摘要
在史无前例的 COVID-19 爆发期间,有报道称 COVID-19 之后出现了新发或复发性肾小球肾炎,如 ANCA 相关性肾小球肾炎和免疫球蛋白 A(IgA)肾病。然而,迄今为止,COVID-19 与之前存在的 IgA 血管炎(IgAV)之间的关联仍不清楚。在此,我们介绍了一例 20 多岁的日本女性病例,她在感染 COVID-19 后出现了肾小球肾炎。确诊 IgAV 时,她有皮肤紫癜、关节痛和胃肠道症状,但没有肾脏受累的迹象。三个月前,她的 COVID-19 检测呈阳性,随后出现血尿和蛋白尿。随后,她住进了我院,肾活检显示肾小球系膜扩张、细胞增生、细胞和纤维新月体,伴有弥漫性 IgA 和 C3 沉积。诊断为新发 IgAV 肾炎后,患者接受了静脉甲基强的松龙治疗,随后口服强的松龙。她对治疗反应良好,在开始使用糖皮质激素治疗后,血尿和蛋白尿得到缓解并得以维持。我们的病例突出表明,对 SARS-CoV-2 感染的免疫反应可诱发无肾脏受累的 IgAV 患者出现肾小球肾炎。
A case of de novo glomerulonephritis following COVID-19 in a patient with preexistent IgA vasculitis.
During the unprecedented COVID-19 outbreak, new-onset or relapsing glomerulonephritis, such as ANCA-associated glomerulonephritis and Immunoglobulin A (IgA) nephropathy, following COVID-19 has been reported. However, to date, the association of COVID-19 with preexistent IgA vasculitis (IgAV) remains unclear. Here, we present the case of a 20-something old Japanese woman with preexistent IgAV who newly developed glomerulonephritis following COVID-19. At the diagnosis of IgAV, she had cutaneous purpura, joint pains, and gastrointestinal symptoms, but no signs of kidney involvement. Three months ago, she was tested positive for COVID-19 and subsequently developed hematuria and proteinuria. She was then admitted to our hospital and renal biopsy showed glomerular mesangial expansion and hypercellularity and cellular and fibrocellular crescents, accompanied by diffuse IgA and C3 deposits. With the diagnosis of de novo IgAV nephritis, the patient was treated with intravenous methylprednisolone followed by oral prednisolone. She had favorable responses to this treatment and has achieved and maintained the remission of hematuria and proteinuria after initiation of glucocorticoid therapy. Our case highlights that immune response to SARS-CoV-2 infection could trigger the onset of glomerulonephritis in the IgAV patients who have no renal involvement.
期刊介绍:
Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN). The journal publishes original case reports in nephrology and related areas. The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.