New Onset Biopsy-Proven Nephropathies after COVID Vaccination

Abstract

<b><i>Introduction:</i></b> To date, almost 7 billion doses of the different types of vaccine against SARS-CoV-2 have been administered worldwide. Although the severity of new cases of SARS-CoV-2 has progressively decreased, and the pressure on national health systems has declined, the development of de novo glomerular injuries has been suggested. <b><i>Methods:</i></b> This study aimed to examine the patients who were hospitalized in our Unit between April and November 2021 and underwent renal biopsy for new-onset urinary abnormalities (UA) and/or renal impairment within 3 months of SARS-CoV-2 vaccination. <b><i>Results:</i></b> We identified 17 patients who developed UA and/or renal insufficiency within 3 months of vaccination. Minimal change disease was the most common disease in our cohort (5 patients, 29.4%) followed by acute tubulointerstitial nephritis (TIN; 3 patients, 17.6%), membranous nephropathy (3 patients, 17.6%), and rapidly progressive IgA nephropathy (2 patients, 11.8%). The other 4 patients had a diagnosis of membranoproliferative glomerulonephritis (1 patient), systemic lupus erythematosus (1 patient), ANCA-associated vasculitis (1 patient), and tip-variant focal segmental glomerulosclerosis (1 patient), respectively. Eight out of the 17 patients (47.1%) developed acute kidney injury. Two patients with acute TIN had to start hemodialysis that was discontinued after 1 and 2 months, respectively, due to the recovery of renal function. All patients underwent treatment with corticosteroids and/or immunosuppressants. <b><i>Discussion:</i></b> Although it is not possible to conclusively determine whether there is a causal relationship between SARS-CoV-2 vaccination and new-onset nephropathies, based on the appearance of UA and/or renal insufficiency shortly after vaccination, we hypothesize that the immune response to the COVID-19 vaccine may be a trigger of nephropathies. Therefore, our results highlight the need for pharmacovigilance. However, this report should not lead to vaccine hesitation during this pandemic as the benefits of vaccination strongly outweigh the potential risks.

New-Onset and Relapsed Membranous Nephropathy post SARS-CoV-2 and COVID-19 Vaccination

“…There were 37 cases reported before 6 September 2022 in 20 articles [ 4 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] ( Table 2 ), including 20 (54.1%) cases with new diagnoses and 17 (45.9%) cases with relapsed or worsening symptoms. The median age of onset was 63.5 (22–84) years, and males accounted for 67.6% (25/37).…”

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

“…To date, only a case series including patients who developed new or relapsing glomerulonephritis (Caza et al, 2021;Fenoglio et al, 2022;Klomjit et al, 2021), or case reports of unique patients who presented AAV following different types of SARS-CoV-2 vaccines (Anderegg et al, 2021;Baier et al, 2022;Garcia et al, 2022;Gupta and Ellis, 2022;Ibrahim et al, 2022;Obata et al, 2021;Prabhahar et al, 2022;Prema et al, 2021;Shakoor et al, 2021;Villa et al, 2021), have been published.…”

“…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). Therefore, to our knowledge, this is the largest study that include patients who debuted with…”

Newly-diagnosed immunoglobulin A nephropathy with increased plasma galactose-deficient-IgA1antibody associated with mRNA COVID-19 vaccination: a case report

“…For example, most reported patients suffering from de novo or relapsed IgAN had received an mRNA vaccine, either BNT-162b2 (Pfizer) or mRNA-1273 (Moderna), 1,2 while a few cases of IgAN were reported after the ChAdOx1-S (AstraZeneca) vaccination. 3 Most cases reported in the literature had mild disease and the IgAN resolved spontaneously after conservative treatments. 4 This current case report describes a patient with newly-diagnosed IgAN that presented with acute kidney failure 2 weeks after receiving the first dose of the mRNA-1273 vaccine.…”