Temporal Clustering of Antiglomerular Basement Membrane Disease in COVID-19 Pandemic: A Case Series

Sebastian, Rakesh; Arunachalam, Jegan; Rajendran, Manorajan

doi:10.2147/ijnrd.s333894

Cited by 13 publications

(12 citation statements)

References 12 publications

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“…It was postulated that COVID-19 virus may infect and damage alveolar endothelial cells, leading to exposure of a cryptic epitope on the non-collagenous domain of type 4 collagen, precipitating the production of autoantibodies [2] . This hypothesis was supported by documented findings of COVID-19 pneumonia in affected individuals in a case series [5] . Interestingly, the prevailing local variant at the time of our patient’s infection was the Omicron variant, which frequently spares the alveolar compartment [6] .…”

supporting

confidence: 57%

“…The inciting factor for remains elusive, although observations of spatial and temporal clustering support the hypothesis of an environmental trigger, including infections [1] . Recent reports of de-novo and relapsing anti-GBM cases occurring in close temporal association with COVID-19 infections have emerged [2 – 5] . We present a case of anti-GBM glomerulonephritis preceded by a mild COVID-19 infection.…”

mentioning

confidence: 99%

“…The close temporal association of anti-GBM glomerulonephritis with the COVID-19 infection suggests a possible link, although the exact initiating mechanism(s) remains obscure. Prior such reports surfaced earlier in the pandemic before the Omicron variant became prevalent [4 , 5] . It was postulated that COVID-19 virus may infect and damage alveolar endothelial cells, leading to exposure of a cryptic epitope on the non-collagenous domain of type 4 collagen, precipitating the production of autoantibodies [2] .…”

mentioning

confidence: 99%

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Anti-glomerular basement membrane glomerulonephritis following COVID-19 infection without clinically evident pneumonia

et al. 2023

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supporting

confidence: 57%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Anti-glomerular basement membrane glomerulonephritis following COVID-19 infection without clinically evident pneumonia

et al. 2023

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“…There is at least 1 case reported of dual anti-GBM and ANCA nephritis following COVID-19 infection. 22 There are also at least 20 cases reported so far of ANCA nephritis following COVID-19 infection 23 and evidence that the frequency of anti-GBM increased with the advent of the COVID-19 pandemic prior to the distribution of COVID-19 vaccines. 24 …”

Section: Discussionmentioning

confidence: 99%

Double-Positive Anti–Glomerular Basement Membrane Antibody and Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody–Associated Glomerulonephritis Post COVID-19 mRNA vaccine: A Case Series of 4 Patients

Ting

Barbir

McRae

et al. 2023

Can J Kidney Health Dis

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Rationale: Vaccines remain central to the management of COVID-19 pandemic, including the need for repeat doses of vaccines to boost immunity. There has been an accumulating case count of glomerulopathies temporally associated with COVID-19 vaccination. This case series presents 4 patients who developed double-positive anti–glomerular basement membrane antibody (anti-GBM) and myeloperoxidase (MPO) antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis after COVID-19 mRNA vaccination. This report contributes to our collective knowledge about the pathophysiology and clinical outcomes associated with this rare complication. Presenting Concerns of the Patient: Four patients developed nephritic syndrome within 1 to 6 weeks after receiving a COVID-19 mRNA vaccine (3 post Pfizer-BioNTech and 1 post Moderna vaccination). Three of the 4 patients also had hemoptysis. Diagnosis: Three of the 4 patients had double-positive serology, whereas the fourth patient had renal biopsy findings consistent with double-positive disease, although anti-GBM serology was negative. All patients had renal biopsy findings consistent with double-positive anti-GBM and ANCA-associated glomerulonephritis. Interventions: All 4 patients were treated with pulse steroids, cyclophosphamide, and plasmapheresis. Outcomes: Of the 4 patients, 1 demonstrated complete remission, 2 remained dialysis-dependent, and the fourth is deceased. Of the 2 patients who received repeat vaccination with COVID-19 mRNA vaccine, 1 patient had second serologic flare of anti-GBM in response to the vaccine. Novel Findings: This case series reinforces growing evidence that COVID-19 mRNA vaccine-induced glomerulonephritis is a rare but real phenomenon. Dual ANCA and anti-GBM nephritis can present after the first dose of COVID-19 mRNA vaccine or after several administrations of the vaccine. We are the first to report cases of double-positive MPO ANCA and anti-GBM nephritis after Pfizer-BioNTech vaccination. To our knowledge, we are also the first to report outcomes of repeat COVID-19 vaccination in patients with de novo flare of ANCA and anti-GBM nephritis temporally associated with COVID-19 vaccination.

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“…There were a total of 9 cases of anti-GBM disease but only 7 cases with reported clinical data. 18 , 98 , 99 , 100 Of 7 patients, 6 patients were Asian, and 1 patient was African American. The median age was 48 years (IQR 32, 57).…”

Section: Kidney Pathology Potentially Related To Covid-19mentioning

confidence: 99%

COVID-19 and Glomerular Diseases

Klomjit¹,

Zand²,

Cornell³

et al. 2023

Kidney International Reports

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Temporal Clustering of Antiglomerular Basement Membrane Disease in COVID-19 Pandemic: A Case Series

Cited by 13 publications

References 12 publications

Anti-glomerular basement membrane glomerulonephritis following COVID-19 infection without clinically evident pneumonia

Anti-glomerular basement membrane glomerulonephritis following COVID-19 infection without clinically evident pneumonia

Double-Positive Anti–Glomerular Basement Membrane Antibody and Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody–Associated Glomerulonephritis Post COVID-19 mRNA vaccine: A Case Series of 4 Patients

COVID-19 and Glomerular Diseases

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