Kidney injury associated with COVID-19 infection and vaccine: A narrative review

Abstract

The respiratory tract is the main infection site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in many admissions to intensive care centers in several countries. However, in addition to lung involvement, kidney injury caused by the novel coronavirus has proven to be a significant factor related to high morbidity and mortality, alarming experts worldwide. The number of deaths has drastically reduced with the advent of large-scale immunization, highlighting the importance of vaccination as the best way to combat the pandemic. Despite the undeniable efficacy of the vaccine, the renal side effects associated with its use deserve to be highlighted, especially the emergence or reactivation of glomerulopathies mentioned in some case reports. This study aimed to identify the main renal morphological findings correlated with COVID-19 infection and its vaccination, seeking to understand the pathophysiological mechanisms, main clinical features, and outcomes.

Renal Biopsy Diagnosis of Acute Tubular Injury after Pfizer-BioNTech COVID-19 Vaccination: A Case Report

“…At the time of initial diagnosis, it was difficult to differentiate ATI from RPGN because of vasculitis or other causes based on only clinical findings and laboratory tests. In addition, according to previous reports, the time lag between COVID-19 vaccination and the onset of RPGN varies from 3 h to 4 weeks, making it difficult to determine whether glomerular injury requiring immunosuppressive treatment occurs only within the time frame between vaccination and the onset of AKI [ 22 ]. Therefore, in cases of rapidly progressing renal dysfunction, empirical treatment with immunosuppressive agents may be unavoidable without waiting for a definitive diagnosis by renal biopsy.…”

Complement-Mediated Thrombotic Microangiopathy Related to COVID-19 or SARS-CoV-2 Vaccination

“…Thrombotic microangiopathy was diagnosed in less than 5% of biopsies, making it a rare type of kidney disease diagnosed in association with COVID-19. 23 , 24 , 25 , 26 , 27 , 28 , 29 In the 2 largest studies, Pacheco et al. 24 and May et al.…”

“… 23 , 24 , 25 , 26 , 27 , 28 , 29 In the 2 largest studies, Pacheco et al. 24 and May et al. 23 described TMA in 3.6% ( n = 12) and 2.1% ( n = 5) of 331 and 250 kidney biopsies, respectively.…”

“…In this context, Pacheco et al. 24 summarized published data on kidney biopsies of patients with postvaccination kidney injury and did not refer to any case of aHUS/cTMA. Nevertheless, as of November 27, 2022, the Vigibase database reported 28 cases of aHUS related to SARS-CoV-2 vaccination.…”

ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review

“…Herein, we report a case from the Brazilian Consortium for the Study of COVID-19-Associated Renal Disease, which collects kidney biopsies from patients with kidney damage secondary to COVID-19 and its vaccine in 42 private and public hospitals ( 4 , 5 ). This is a case report of ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination, and a review of kidney manifestations related to this vaccine.…”