De Novo and Relapsing Glomerulonephritis following SARS-CoV-2 mRNA Vaccination in Microscopic Polyangiitis

Abstract

Vaccination against SARS-CoV-2 is the most important advance in the fight against the ongoing coronavirus pandemic. Recent case reports show that the SARS-CoV-2 vaccines can very rarely cause de novo or relapsing glomerular disease. Here, we report two female patients with microscopic polyangiitis, who developed severe glomerulonephritis after immunisation with the BNT162b2 mRNA vaccine. One patient with a possible ongoing but undiagnosed disease developed severe necrotising glomerulonephritis after the second vaccination. In the other patient with a long-lasting disease, rituximab maintenance therapy had been postponed because of the coronavirus pandemic. She noted macrohematuria immediately after the second vaccine dose and developed a severe renal relapse leading to end-stage kidney disease. We suggest that patients with ANCA-associated vasculitis be carefully monitored for disease activity immediately before and after receiving the SARS-CoV-2 vaccination, especially if maintenance therapy has been interrupted. Ultimately, mRNA vaccines should probably be avoided in these patients.

Cardiac Tamponade as a Complication of Microscopic Polyangiitis: A Case Associated With a COVID-19 mRNA Vaccine

“…These authors also observed the reduction of the ANCA response to the RNA vaccine once it was treated with ribonuclease. ANCA vasculitis has been reported in connection with COVID-19 infection and the different types of vaccination to prevent it [2][3][4][5][6]17,18], prompting the suspicion of whether the immunological phenomenon is a direct result of the mRNA content of the vaccine. Hypothesized mechanisms like molecular mimicry, defective neutrophilic apoptosis, polyclonal activation, and a systemic proinflammatory cytokine response can explain the temporal causal association between autoimmune manifestations of ANCA vasculitis and COVID-19 vaccines.…”

“…As vaccination rates increase, rare side effects begin to emerge. Cases of small-vessel vasculitis have been reported following the administration of the different COVID-19 vaccines [2][3][4][5][6][7][8][9][10]. Only a few instances of microscopic polyangiitis (MPA) following Pfizer-BioNTech mRNA vaccine administration have been reported in English literature [2][3][4][5][6].…”

“…Cases of small-vessel vasculitis have been reported following the administration of the different COVID-19 vaccines [2][3][4][5][6][7][8][9][10]. Only a few instances of microscopic polyangiitis (MPA) following Pfizer-BioNTech mRNA vaccine administration have been reported in English literature [2][3][4][5][6]. MPA is a systemic necrotizing small-vessel vasculitis that predominantly affects the pulmonary and renal systems.…”

Increased induction of de novo serum ANCA and ANCA-associated vasculitis after mass vaccination against SARS-CoV-2

“…ANCA-associated vasculitis (AAV) is characterized by the development of autoantibodies against antigens in cytoplasmic granules of neutrophils affecting predominantly to small vessels, with myeloperoxidase (MPO) or proteinase 3 (PR3) being the main antigens toward which these autoantibodies are directed. Although the development of ANCA after influenza vaccination has been previously reported, most of the studies that analyze the possible relationship between SARS-CoV-2 vaccination and the development of ANCA and AAV correspond to case reports (Chen et al, 2021;Davidovic et al, 2021;Dube et al, 2021;Feghali et al, 2021;Felzer et al, 2021;Hakroush and Tampe, 2021;Okuda et al, 2021). Likewise, the few published works that include series of patients and review the temporal association between glomerular disease and SARS-CoV-2 vaccination only include very few cases of AAV, as these studies consider the effect of the vaccine on the development of different types of glomerulonephritis, such as immunoglobulin A (IgA) nephropathy, membranous nephropathy, minimal change disease, collapsing glomerulopathy, or lupus nephritis (Caza et al, 2021;Fenoglio et al, 2022;Klomjit et al, 2021).…”

ANCA Associated Glomerulonephritis Following SARS-CoV-2 Vaccination: A Case Series and Systematic Review

“…The following supporting information can be downloaded at: , Table S1: Clinical spectrums and outcomes of ANCA-associated glomerulonephritis following SARS-CoV-2 vaccination. Refs [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] mentioned in Supplementary Materials.…”