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De novo posttransplant membranous nephropathy after COVID-19 vaccination 9 years after renal transplantation in a patient with polycystic kidney disease

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Abstract

A 63-year-old man with polycystic kidney disease underwent kidney transplantation from his wife. Nine years later, after the first and second doses of the COVID-19 vaccination, he developed proteinuria, hematuria, and elevated C-reactive protein. Kidney biopsy 7 months after the initial appearance of proteinuria showed immunoglobulin (Ig)-G granular stain, predominantly IgG1, and spike formation in the glomerular basement membrane. Electron microscopy revealed mainly subepithelial deposits, which corresponds to membranous nephropathy (MN) stage 3 of the Ehrenreich–Churg classification indicating chronic disease, but it also showed electron-dense deposits and endothelial damage. Because a kidney biopsy was performed 1 h after renal transplantation and a biopsy of the patient’s native kidney showed intact glomeruli, atypical de novo posttransplant membranous nephropathy (MN) was diagnosed, and a close relationship with COVID-19 vaccination was assumed. Clinicians should consider the involvement of COVID-19 vaccination in de novo posttransplant MN with unclear pathogenesis.

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Authors and Affiliations

  1. Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Miruzato Fukuda, Takayoshi Yokoyama, Katsuyuki Miki, Masayuki Yamanouchi, Daisuke Ikuma, Hiroki Mizuno, Yuki Oba, Noriko Inoue, Akinari Sekine, Kiho Tanaka, Eiko Hasegawa, Tatsuya Suwabe, Takehiko Wada, Yuki Nakamura, Yasuo Ishii, Naoki Sawa & Yoshifumi Ubara

  2. Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

    Miruzato Fukuda, Takayoshi Yokoyama, Katsuyuki Miki, Masayuki Yamanouchi, Daisuke Ikuma, Hiroki Mizuno, Yuki Oba, Noriko Inoue, Akinari Sekine, Kiho Tanaka, Eiko Hasegawa, Tatsuya Suwabe, Takehiko Wada, Yuki Nakamura, Yasuo Ishii, Naoki Sawa & Yoshifumi Ubara

  3. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    Kei Kono, Keiichi Kinowaki & Kenichi Ohashi

  4. Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Ohashi

  5. Yamaguchi’s Pathology Laboratory, Chiba, Japan

    Yutaka Yamaguchi

Authors
  1. Miruzato Fukuda
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  2. Takayoshi Yokoyama
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  3. Katsuyuki Miki
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  4. Masayuki Yamanouchi
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  5. Daisuke Ikuma
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  6. Hiroki Mizuno
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  7. Yuki Oba
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  8. Noriko Inoue
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  9. Akinari Sekine
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  10. Kiho Tanaka
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  11. Eiko Hasegawa
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  12. Tatsuya Suwabe
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  13. Takehiko Wada
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  14. Kei Kono
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  15. Keiichi Kinowaki
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  16. Kenichi Ohashi
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  17. Yutaka Yamaguchi
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  18. Yuki Nakamura
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  19. Yasuo Ishii
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  20. Naoki Sawa
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  21. Yoshifumi Ubara
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Contributions

Dr. Fukuda: study concept and design and data acquisition; Drs. Sawa, Suwabe: data analysis and interpretation; Drs. Ikuma, Mizuno, Oba, Sekine, Hasegawa, Yamanouchi: study supervision; Drs. Kono, Kinowaki, Ohashi, Yamaguchi: histological analysis; Drs. Nakamura, Miki, Yokoyama, Ishii: surgery; Dr. Ubara: critical revision of the manuscript for important intellectual content.

Corresponding authors

Correspondence to Miruzato Fukuda or Yoshifumi Ubara.

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The authors have no competing financial interests or conflicts of interest to declare.

Ethical approval

This investigation was performed in accordance with the Declaration of Helsinki. The patient gave written informed consent for this case report to be published.

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Cite this article

Fukuda, M., Yokoyama, T., Miki, K. et al. De novo posttransplant membranous nephropathy after COVID-19 vaccination 9 years after renal transplantation in a patient with polycystic kidney disease. CEN Case Rep (2024). https://doi.org/10.1007/s13730-024-00864-4

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  • DOI: https://doi.org/10.1007/s13730-024-00864-4

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