Letter regarding: “A Case of Gross Hematuria and IgA Nephropathy Flare-Up Following SARS-CoV-2 Vaccination”

Park, Ken; Miyake, Scott; Tai, Cynthia; Tseng, Mindy; Andeen, Nicole K.; Kung, Vanderlene L.

doi:10.1016/j.ekir.2021.06.007

Cited by 25 publications

(28 citation statements)

References 3 publications

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“…Six cases of new onset IgA nephropathy were reported in patients presenting with macroscopic hematuria following COVID-19 vaccination [25][26][27][28][29]. The median (IQR) age of the group was 40 (27 to 50) years, with a male: female ratio of 4:2.…”

Section: Iga Nephropathymentioning

confidence: 99%

“…Management for all six patients was supportive and a resolution of symptoms was noted in all the reported cases. Park et al [29] reported two female patients, aged 22 and 39 years, presenting with gross hematuria and mild proteinuria without a rise in creatinine within two days of the second dose of Moderna vaccination, with spontaneous resolution noted on follow-up at 1 month. One patient had a history of receiving episodic steroids for IgA vasculitis at the age of 10 years old.…”

Section: Iga Nephropathymentioning

confidence: 99%

“…A serum antinuclear antibody screening test on fixed Hep-2 cells showed the autoreactivity of the patient's IgA after the mRNA vaccination, which was not present before the vaccination, supporting the link between vaccination and IgA vasculitis flare. Park et al [29] reported another case of IgA vasculitis in a 67-year-old man who presented with gross hematuria and a lower extremity rash one month after his first dose of the Moderna vaccine. A skin biopsy showed IgA vasculitis.…”

Section: Vasculitismentioning

confidence: 99%

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New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

Kalra

Chinnadurai

2021

Vaccines

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Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review. Results: Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy. Conclusion: This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.

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Section: Iga Nephropathymentioning

confidence: 99%

Section: Iga Nephropathymentioning

confidence: 99%

Section: Vasculitismentioning

confidence: 99%

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New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

Kalra

Chinnadurai

2021

Vaccines

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“…Along with increasing wide availability of those vaccines, cases of vaccine-related new-onset glomerular diseases, including minimal change disease (MCD) [ 1 – 5 ], anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis [ 6 , 7 ], and immunoglobulin A (IgA) nephropathy [ 8 ], that developed after receiving the BNT162b2 mRNA COVID-19 vaccine have been reported. Furthermore, cases of MCD [ 9 ], ANCA-associated vasculitis [ 10 , 11 ], and IgA nephropathy [ 11 – 13 ] have also been reported in individuals who received the mRNA-1273 COVID-19 vaccine.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have noted occurrence of IgA vasculitis following vaccinations for influenza [ 16 ] and hepatitis A [ 17 ]. New-onset IgA vasculitis after receiving the BNT162b2 mRNA COVID-19 vaccine has also been reported [ 18 , 19 ], in which kidney function and urinalysis were normal, as well as a case of new onset IgA vasculitis in an individual who received the mRNA-1273 COVID-19 vaccine [ 13 ]. However, a kidney biopsy was not performed for any of those latter three patients, thus no renal histopathological information regarding new-onset IgA vasculitis with kidney involvement after receiving the mRNA COVID-19 vaccine has been made available.…”

Section: Introductionmentioning

confidence: 99%

New-onset kidney biopsy-proven IgA vasculitis after receiving mRNA-1273 COVID-19 vaccine: case report

et al. 2022

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As mRNA COVID-19 vaccines have become widely available, cases of new-onset glomerular disease after receiving COVID-19 vaccination have been reported. Here, we present a case of kidney biopsy-proven new-onset IgA vasculitis after receiving the mRNA-1273 (Moderna) COVID-19 vaccination. A 47-year-old man with a 10-year medical history of hypertension and hyperuricemia visited our hospital 19 days after receiving an initial mRNA-1273 COVID-19 vaccine injection for purpuric eruption on the legs and dorsal regions of the feet. Although the eruptions spontaneously improved within 5 days, they developed again at 15 days after the second injection. A histopathological examination of skin biopsy specimens was reminiscent of leukocytoclastic vasculitis, though direct immunofluorescence did not indicate IgA deposition within small vessel walls. Urinalysis indicated severe proteinuria (3 +) and occult blood (3 +). Thus, a kidney biopsy was performed and light microscopy revealed mild mesangial expansion, hypercellularity, and endocapillary hypercellularity, with cellular and fibrocellular crescents observed in three and one, respectively, of a total of 15 glomeruli. Immunofluorescence also showed diffuse granular mesangial staining (3 +) for IgA. Histopathological features were consistent with IgA vasculitis. Intravenous methylprednisolone at 1000 mg for 3 days was initiated, followed by oral prednisolone (0.6 mg/kg/day). Over the following 2-week period, serum creatinine level improved from 1.24 to 1.06 mg/dL and proteinuria decreased from 2.98 to 0.36 g/g Cr, though occult blood persisted. Findings in the present case indicate that new-onset IgA vasculitis after receiving mRNA-1273 COVID-19 vaccine can be treated with corticosteroid therapy.

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Pathology findings in pediatric patients with COVID-19 and kidney dysfunction

et al. 2022

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Background Acute kidney injury (AKI) is seen in one-fifth of pediatric patients with COVID-19 requiring hospital admission, and is associated with increased morbidity, mortality, and residual kidney impairment. The majority of kidney pathology data in patients with COVID-19 is derived from adult case series and there is an overall lack of histologic data for most pediatric patients with COVID-19. Methods We assembled a multi-institutional cohort of five unvaccinated pediatric patients with COVID-19 and associated kidney dysfunction with available histology. Results Three complex patients with current or prior SARS-CoV-2 infection had multifactorial thrombotic microangiopathy with clinical features of hemolytic uremic syndrome (in two) or disseminated intravascular coagulation (in one); one died and another developed chronic kidney disease stage 5. Two with recently preceding SARS-CoV-2 infection presented with nephrotic syndrome; one had IgA vasculitis and one had minimal change disease. Within a short follow-up time, none has returned to baseline kidney function. Conclusion Although uncommon, COVID-19-associated kidney injury can have significant morbidity in the unvaccinated pediatric and adolescent population.

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Letter regarding: “A Case of Gross Hematuria and IgA Nephropathy Flare-Up Following SARS-CoV-2 Vaccination”

Cited by 25 publications

References 3 publications

New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

New-onset kidney biopsy-proven IgA vasculitis after receiving mRNA-1273 COVID-19 vaccine: case report

Pathology findings in pediatric patients with COVID-19 and kidney dysfunction

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