Association between COVID-19 vaccination and relapse of glomerulonephritis.

BACKGROUND: Vaccines for coronavirus disease 2019 (COVID-19) have been developed and are recommended for patients with chronic kidney disease; however, it has been reported that glomerulonephritis worsens after vaccination. We aimed to elucidate the incidence and association between COVID-19 vaccination and glomerulonephritis relapse. METHODS: We investigated the onset of renal events and adverse reactions after COVID-19 vaccination in 111 patients diagnosed with glomerulonephritis. Renal events were defined as worsening hematuria, increased proteinuria, and an increased creatine level over 1.5-fold from baseline. RESULTS: Patients were 57 ± 18 years old (55.9% female) and had an estimated glomerular filtration rate of 57.0 ± 25.0 ml/min/1.73 m2. A pathological diagnosis of IgA nephropathy was confirmed in 55.0%, minimal change disease in 22.5%, and membranous nephropathy in 10.8% of the patients. The BNT162b2 (Pfizer) and mRNA-1273 (Moderna) vaccines were administered in 88.2% and 11.7% of the cases, respectively. Renal events were observed in 22.5% of patients, 10.8% had increased proteinuria, 12.6% had worsening hematuria, and 1.8% received additional immunosuppressive treatment. Only 0.9% required temporary hemodialysis from exacerbation of renal dysfunction. Renal events were higher in younger patients (P = 0.02), being highest in those with IgA nephropathy, but there was no difference in the incidence between pathological diagnoses. There was a significantly higher incidence of renal events in patients with fever (P = 0.02). CONCLUSIONS: COVID-19 vaccination and glomerulonephritis relapse may be related, but further research is needed.

Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series.

INTRODUCTION: Hemodialysis patients with atrial fibrillation are at high risk for stroke. Intravenous recombinant tissue plasminogen activator is considered for acute ischemic stroke. However, recombinant tissue plasminogen activator therapy is contraindicated for some hemodialysis patients with atrial fibrillation. These patients and those who have received recombinant tissue plasminogen activator therapy without blood flow recovery are candidates for endovascular therapy. METHODS AND RESULTS: Three hemodialysis patients with atrial fibrillation received endovascular therapy for acute cerebral infarction. Cerebrovascular incident occurred during or after hemodialysis in two of these patients. All three patients achieved successful recanalization after endovascular therapy. CONCLUSION: In this series, endovascular therapy showed good results without complications. More cases should be investigated to obtain more evidence of successful endovascular therapy for hemodialysis patients.

A case of mild phenotype Alport syndrome caused by COL4A3 mutations.

In a case of 41-year-old man with mild nephropathy, Alport syndrome (AS) was diagnosed from the renal biopsy. However, the α5 chain of type IV collagen expressed in the glomerular basement membrane, which was the atypical staining pattern of AS. Genetic testing suggested autosomal recessive AS from heterozygous mutations at two positions in the type IV collagen α3 chain. These two gene mutations represented a new pattern of mutation and was suggested the association with an atypical α5 chain expression and mild phenotype.