Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases

Abstract

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several case reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated glomerulonephritis, collapsing glomerulopathy, and diffuse lupus nephritis diagnosed on kidney biopsies post-immunization, as well as recurrent ANCA-associated glomerulonephritis. This included 28 cases of de novo glomerulonephritis within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of African American descent and had two APOL1 genomic risk alleles. A brief literature review of case reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown, however, there was no overall increase in incidence of glomerular disease when compared to the two years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: This suggests that glomerulonephritis in response to vaccination is rare, although should be monitored as a potential adverse event.

Incidence of Glomerulonephritis after SARS-CoV-2 mRNA Vaccination

“…Temporal association of glomerulonephritis with SARS-CoV-2 vaccination has not been uniformly defined in case reports and case series, with the largest case series defining it as onset of symptoms within one month of any vaccine dose. 6 In 15 patients of our cohort, glomerulonephritis definitely (n=4) or possibly (n=11) manifested within 28 days of a vaccine dose. The clinical characteristics of these patients compared to all other patients with a diagnosis of glomerulonephritis during the study period are shown in Table 4 .…”

New-onset and relapse of nephrotic syndrome following COVID-19 vaccination: a questionnaire survey in Japan

“…To date, there have been several reports of new-onset and relapse of NS following COVID-19 vaccination [ 8 – 14 , 20 ]. Vaccinations based on several mechanisms of triggering an immune response have been developed and administered; however, most cases of new-onset and relapse of NS have been reported with mRNA vaccination.…”

“…If yearly “booster” vaccines against COVID-19 are recommended, should patients who develop NS post-vaccination avoid repeat exposure to the vaccine? As previously mentioned, one potential option is to switch to a different COVID-19 vaccine to minimize the possibility of relapse since some patients have relapsed again on receiving vaccinations of the same type [ 8 , 20 , 24 ]. Although some of our case series had already been reported in detail as case reports [ 13 , 14 ], it will require an understanding of the nature and severity of glomerular diseases in individual patients.…”

Probable Vogt–Koyanagi–Harada Disease after COVID-19 Vaccination: Case Report and Literature Review

“…Furthermore, we need to consider the possible causal link between kidney damage and recent vaccination. Except for the numbers of case reports, a series of 29 cases of glomerular disease, including IgA nephropathy, minimally changed disease, membranous nephropathy, and Anti-neutrophil cytoplasmic antibodies (ANCA)-associated Glomerular Nephritis (GN), suggested that newly onset or recurrent glomerular disease should be monitored as a potential adverse event of the COVID-19 vaccine [ 30 ]. In our case report, although the IgA nephropathy discovered one month after the patient’s first evaluation was considered to exist long before the onset of VKH disease, according to the clinical (stage III CKD) and pathological (nephrosclerosis (70%)) diagnosis, we cannot rule out the possibility that the vaccine aggravated the kidney damage.…”