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Chen CH, Chiu YW, Chen BD, Wu MJ, Tsai SF. De Novo Biopsy-Proven Glomerular Disease Following COVID-19 Vaccination. J Clin Med 2024; 13:4494. [PMID: 39124761 PMCID: PMC11313347 DOI: 10.3390/jcm13154494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background: There is still no consensus about the coronavirus disease 2019 (COVID-19) vaccine-associated glomerular disease (CVAGD). Given the large number of vaccinations administered and the variations in glomerulopathy observed across different countries and regional environments, CVAGD remains an important area of concern. Aim of study: We aimed to elucidate the findings of CVAGD within a Taiwanese cohort using biopsy data. Additionally, we endeavored to clarify the presentation of CVAGD. Methods: We collected data from patients who underwent renal biopsy from June 2021 to October 2022 at Taichung Veterans General Hospital. Two independent nephrologists meticulously reviewed the charts to exclude cases unrelated to vaccination. Results: Initially, a total of 286 patients underwent renal biopsy at our institute. Ultimately, we identified 14 patients with highly suspected CVAGD. All 14 patients exhibited proteinuria and hematuria. The urinary protein-to-creatinine ratio was elevated (median of 2012.1 mg/g; interquartile range (IQR) 25%-IQR 75%: 941.85-3884.1 mg/g) with a median serum creatinine level of 1.71 mg/dL (0.79-5.35). The majority of CVAGD cases were diagnosed as immunoglobulin A (IgA) nephropathy (n = 5, 35.7%), followed by antineutrophil cytoplasmic antibody (ANCA)-related rapidly progressive glomerulonephritis (RPGN) (n = 4, 28.6%). There were only three cases of minimal change disease each: one case of focal segmental glomerulosclerosis, one of membranous glomerulonephritis, and one of lupus nephritis. The culprit of COVID-19 vaccinations was 35.7% (n = 5) of Oxford-AstraZeneca (ChAdOx1-S), 42.9% (n = 6) of Moderna, and 21.4% (n = 3) of BNT162b2. Most patients experienced improvements in renal function. Only two cases of P-ANCA RPGN and one case of IgA nephropathy did not recover. Eighty percent of IgA nephropathy cases had favorable outcomes, but none of the patients with P-ANCA RPGN achieved full recovery. Conclusions: IgA nephropathy and ANCA-related RPGN were the most common CVAGD, and all types of COVID-19 vaccines posed a risk for CVAGD. However, further studies are required to confirm causality.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung 407, Taiwan (Y.-W.C.)
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- PhD Program, Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Yu-Wei Chiu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung 407, Taiwan (Y.-W.C.)
- Shinfu Clinic, Taichung 411, Taiwan
| | - Bo-Ding Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung 407, Taiwan (Y.-W.C.)
- Guomao Clinic, Taichung 436, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung 407, Taiwan (Y.-W.C.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Sec. 3, Taiwan Boulevard, Taichung 407, Taiwan (Y.-W.C.)
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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2
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Li Y, Gong Y, Xu G. New insights into kidney disease after COVID-19 infection and vaccination: histopathological and clinical findings. QJM 2024; 117:317-337. [PMID: 37402613 DOI: 10.1093/qjmed/hcad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
In addition to its pulmonary effects, coronavirus disease 2019 (COVID-19) has also been found to cause acute kidney injury (AKI), which has been linked to high mortality rates. In this review, we collected data from 20 clinical studies on post-COVID-19-related AKI and 97 cases of AKI associated with COVID-19 vaccination. Acute tubular injury was by far the most common finding in the kidneys of patients with COVID-19-related AKI. Among patients hospitalized for COVID-19, 34.0% developed AKI, of which 59.0%, 19.1% and 21.9% were Stages 1, 2 and 3, respectively. Though kidney disease and other adverse effects after COVID-19 vaccination overall appear rare, case reports have accumulated suggesting that COVID-19 vaccination may be associated with a risk of subsequent kidney disease. Among the patients with post-vaccination AKI, the most common pathologic findings include crescentic glomerulonephritis (29.9%), acute tubular injury (23.7%), IgA nephropathy (18.6%), antineutrophil cytoplasmic autoantibody-associated vasculitis (17.5%), minimal change disease (17.5%) and thrombotic microangiopathy (10.3%). It is important to note that crescentic glomerulonephritis appears to be more prevalent in patients who have newly diagnosed renal involvement. The proportions of patients with AKI Stages 1, 2 and 3 after COVID-19 vaccination in case reports were 30.9%, 22.7% and 46.4%, respectively. In general, clinical cases of new-onset and recurrent nephropathy with AKI after COVID-19 vaccination have a positive prognosis. In this article, we also explore the underlying pathophysiological mechanisms of AKI associated with COVID-19 infection and its vaccination by describing key renal morphological and clinical features and prognostic findings.
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Affiliation(s)
- Yebei Li
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Yan Gong
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
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3
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Fukuda M, Yokoyama T, Miki K, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Inoue N, Sekine A, Tanaka K, Hasegawa E, Suwabe T, Wada T, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Nakamura Y, Ishii Y, Sawa N, Ubara Y. De novo posttransplant membranous nephropathy after COVID-19 vaccination 9 years after renal transplantation in a patient with polycystic kidney disease. CEN Case Rep 2024:10.1007/s13730-024-00864-4. [PMID: 38520631 DOI: 10.1007/s13730-024-00864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
A 63-year-old man with polycystic kidney disease underwent kidney transplantation from his wife. Nine years later, after the first and second doses of the COVID-19 vaccination, he developed proteinuria, hematuria, and elevated C-reactive protein. Kidney biopsy 7 months after the initial appearance of proteinuria showed immunoglobulin (Ig)-G granular stain, predominantly IgG1, and spike formation in the glomerular basement membrane. Electron microscopy revealed mainly subepithelial deposits, which corresponds to membranous nephropathy (MN) stage 3 of the Ehrenreich-Churg classification indicating chronic disease, but it also showed electron-dense deposits and endothelial damage. Because a kidney biopsy was performed 1 h after renal transplantation and a biopsy of the patient's native kidney showed intact glomeruli, atypical de novo posttransplant membranous nephropathy (MN) was diagnosed, and a close relationship with COVID-19 vaccination was assumed. Clinicians should consider the involvement of COVID-19 vaccination in de novo posttransplant MN with unclear pathogenesis.
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Affiliation(s)
- Miruzato Fukuda
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
| | - Takayoshi Yokoyama
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Katsuyuki Miki
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Noriko Inoue
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kiho Tanaka
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Takehiko Wada
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yuki Nakamura
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yasuo Ishii
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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4
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Zhang P, Wu Q, Xu X, Chen M. A case of IgG4-related ophthalmic disease after SARS-CoV-2 vaccination: case report and literature review. Front Immunol 2024; 15:1303589. [PMID: 38455056 PMCID: PMC10917890 DOI: 10.3389/fimmu.2024.1303589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
Coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is affecting the world with a surge in cases. A variety of autoimmune diseases occur after SARS-CoV-2 infection or vaccination, of which IgG4-related disease (IgG4-RD) is an important type. IgG4-RD can involve multiple organs of the body. The ocular manifestation of IgG4-RD is called IgG4-related ophthalmic disease (IgG4-ROD). We herein report a patient diagnosed with IgG4-ROD. The patient developed ptosis and vision loss after SARS-CoV-2 vaccination, and the symptoms worsened after SARS-CoV-2 infection. After excluding other diseases like myasthenia gravis and Eaton-Lambert syndrome that may cause ptosis, the diagnosis of IgG4-ROD was confirmed by pathological examination. We discussed the predisposing factors, diagnosis and treatment of this patient to provide a more empirical and theoretical basis for clinical diagnosis and treatment. We conducted a literature review of previously reported cases of IgG4-RD following SARS-CoV-2 infection or vaccination. We retrieved a total of 9 cases, of which 5 developed symptoms after vaccination and 4 after infection. Demographic and clinical characteristics were summarized. In conclusion, our case represents the first case of proven IgG4-ROD after COVID-19 vaccination. We believe that IgG4-ROD and SARS-CoV-2 infection or vaccination are closely related, and the immune system disorder caused by SARS-CoV-2 infection or vaccination may be a key factor in the pathogenesis of IgG4-RD. But for now, there is no direct evidence that there is a causal relationship between SARS-CoV-2 infection or vaccination and IgG4-ROD, which still needs more research and exploration to confirm.
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Affiliation(s)
- Peixuan Zhang
- Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Wu
- Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Medical Service, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao Xu
- Senior Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minliang Chen
- Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, Beijing, China
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5
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Campos MAG, Valois TDO, Magalhães LE, Vasques LF, de Medeiros RG, Costa DMDN, Salgado Filho N, Nogueira RMDR, Neves PDMDM, Silva GEB. ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review. Front Immunol 2024; 14:1298622. [PMID: 38299140 PMCID: PMC10828972 DOI: 10.3389/fimmu.2023.1298622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
With the coverage of COVID-19 vaccination, it has been possible to observe the potential side effects of SARS-CoV-2 vaccines, with the most common ones being fever, myalgia, headache, and fatigue. However, an association has been observed between new and recurrent kidney injuries, mainly glomerulonephritis and lupus nephritis associated with ANCA, with the Pfizer-BioNTech, Moderna, Sinovac, and AstraZeneca vaccines, although the relationship between them is not clear. We report a case of ANCA-related vasculitis and lupus glomerulonephritis after the second dose of the AstraZeneca vaccine. The elderly patient presented significant worsening of kidney function after immunosuppression and complications after a new onset COVID-19 infection that led to death. We provide a literature review about kidney damage related to ANCA vasculitis after COVID-19 vaccine, aiming for a better understanding of the pathophysiological mechanism of kidney injury, its presentation, and treatment.
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Affiliation(s)
- Marcos Adriano Garcia Campos
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | - Tiago de Oliveira Valois
- Divison of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Luís Eduardo Magalhães
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | | | | | - Denise Maria do Nascimento Costa
- Divison of Nephrology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Recife Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Natalino Salgado Filho
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | | | | | - Gyl Eanes Barros Silva
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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6
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de Araújo EMC, Campos MAG, Sodré AM, de Holanda MI, Hagemann R, Teixeira Júnior AAL, Salgado Filho N, Neves PDMDM, Silva GEB. Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review. Vaccines (Basel) 2024; 12:62. [PMID: 38250875 PMCID: PMC10821173 DOI: 10.3390/vaccines12010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Large-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.
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Affiliation(s)
- Emmy Marjorie Carvalho de Araújo
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | - Marcos Adriano Garcia Campos
- Clinical Hospital of Botucatu Medical School, São Paulo State University, Professor Mário Rubens Guimarães Montenegro Avenue, Botucatu 18618-687, Brazil;
| | - Andressa Monteiro Sodré
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | | | - Rodrigo Hagemann
- Clinical Hospital Complex, Federal University of Paraná, General Carneiro Street, Curitiba 80060-900, Brazil;
| | | | - Natalino Salgado Filho
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | | | - Gyl Eanes Barros Silva
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto 14040-900, Brazil
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7
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Vongchaiudomchoke T, Cheunsuchon B, Noppakun K. Membranous nephropathy following SARS-CoV-2 mRNA-1273 vaccination. Med Clin (Barc) 2023; 161:504-505. [PMID: 37573168 DOI: 10.1016/j.medcli.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/14/2023]
Affiliation(s)
| | - Boonyarit Cheunsuchon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, and Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
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8
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Anastassopoulou C, Boufidou F, Hatziantoniou S, Vasileiou K, Spanakis N, Tsakris A. Adverse events of acute nephrotoxicity reported to EudraVigilance and VAERS after COVID-19 vaccination. Vaccine 2023; 41:7176-7182. [PMID: 37891048 DOI: 10.1016/j.vaccine.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES The present study aimed to estimate the reporting rates (RRs) of acute kidney injury (AKI) and renal failure (RF) after COVID-19 vaccination in the European Economic Area (EEA) and the United States. METHODS We retrieved and analyzed pharmacovigilance data on suspected AKI and RF cases and fatalities post COVID-19 vaccination with licensed vaccines reported to EudraVigilance and VAERS between week 52/2020 and week 52/2022 or week 1/2023, respectively. Reporting rates with 95% confidence intervals were estimated per million administered vaccine doses. RESULTS In total, 4,244 AKI and 1,557 RF suspected cases were notified to EudraVigilance (1,692 AKI/971 RF) and VAERS (2,552 AKI/586 RF) during the study period following the administration of >1.6 billion COVID-19 vaccine doses (EEA: 970,934,453/US: 666,511,603). The overall RRs were 3.03 (95 % CI: 2.94-3.12) for AKI and 1.11 (95 % CI: 1.06-1.17) for RF per million administered vaccine doses. Indices for statistically significant increased risks were found in subjects, especially males, ≥65 years compared to 18-64 years old (AKI: OR = 7.23, 95 % CI: 6.63-7.88, p = 0.000, and RF: OR = 4.74, 95 % CI: 3.99-5.63, p < 0.001). AKI reporting rates were higher in the US, while RF reporting rates were higher in Europe. Both potential side effects were elevated following vectored rather than mRNA vaccines, with the highest reporting rates post AD26.COV2.S vaccination in the US (AKI: RR = 12.24, 95 % CI: 10.66-13.81; RF: RR = 3.17, 95 % CI: 2.36-3.97). There were 1,312 deaths possibly associated with AKI (RR = 0.94, 95 % CI: 0.89-0.99) and 460 deaths possibly associated with RF (RR = 0.33, 95 % CI: 0.30-0.36) per million vaccine doses. Fatalities were lower in Europe than in the US (AKI: OR = 0.25, 95 % CI: 0.22-0.28, p < 0.001; RF: OR = 0.82, 95 % CI: 0.69-0.99, p = 0.036). CONCLUSIONS AKI and RF may be observed rarely following vaccination against COVID-19. Further studies are warranted to confirm these findings and uncover the underlying pathophysiological mechanism.
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Affiliation(s)
- Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1(st) Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | | | - Nikolaos Spanakis
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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9
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Chen CH, Wu MJ, Tsai SF. Safety and effectiveness of COVID-19 vaccines in patients with IgA nephropathy: a retrospective cohort study from the TriNetX global collaborative networks. EClinicalMedicine 2023; 65:102306. [PMID: 38021374 PMCID: PMC10661495 DOI: 10.1016/j.eclinm.2023.102306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aimed to evaluate the renal safety and effectiveness of COVID-19 vaccination in patients with immunoglobulin A nephropathy (IgAN). Methods We conducted a global and retrospective collaborative network analysis using TriNetX data from September 11, 2018 to September 11, 2023, to address this question. The study recorded diagnoses of IgAN, COVID-19 vaccinations, and outcomes of effectiveness using International Classification of Diseases, Tenth Revision, Clinical Modification codes and procedure codes. Propensity score matching (PSM) created matched groups (1:1). Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for outcomes of effectiveness, and Kaplan-Meier method assessed survival probability. Safety outcomes regarding renal function were compared with estimated glomerular filtration rate (eGFR), proteinuria, and hematuria. Subgroup analyses were based on sex and age group. Sensitivity analysis was done before the outbreak of Omicron (from September 11, 2018 to October 31, 2021). Findings The study involved 1010 vaccinated and 2776 unvaccinated patients with IgAN without COVID-19 infection at baseline. After PSM (1:1) with 25 variables, both groups consisted of well-matched 979 patients who were relatively young (around 55 years old) and in good health (eGFR: 78-80 ml/min/1.732 m2). Compared to the non-vaccinated group, vaccinated patients had significantly lower risks of COVID-19 infection and complications, including COVID-19 infection (HR: 0.050, 95% CI: 0.026, 0.093), COVID-19 pneumonia (HR: 0), severe lung complication (0.647, 95% CI: 0.421, 0.994), acute respiratory failure (0.625, 95% CI: 0.400, 0.978), sepsis (0.545, 95% CI: 0.334, 0.890), emergency department visits (0.716, 95% CI: 0.615, 0.833), all hospitalizations (0.573, 95% CI: 0.459, 0.715), and mortality (0.595, 95% CI: 0.366, 0.969). However, one month after the follow-up, the vaccinated group exhibited a slightly, but statistically significantly, lower eGFR compared to the non-vaccinated group (73.58 vs. 83.05 ml/min/1.732 m2, p = 0.047). Nine months after the follow-up, the difference in eGFR between the two groups disappeared. The lower risk of COVID-19 infection was observed across genders (male and female) and age groups (young and old). For the period before Omicron outbreak, results were also similar. Interpretation In the largest TriNetX matched cohort study of IgAN, COVID-19 vaccination was associated with a reduced risk of COVID-19 infection and associated complications. However, careful monitoring of renal function, especially GFR, is advisable. Funding This study was supported by grant TCVGH-1103602C, TCVGH-1103601D, and TCVGH-1113602D from Taichung Veterans General Hospital.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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10
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Chuang GT, Lin WC, Chang LY, Tsai IJ, Tsau YK. Pediatric glomerulopathy after COVID-19 vaccination: A case series and review of the literature. J Formos Med Assoc 2023; 122:1125-1131. [PMID: 37147241 PMCID: PMC10130328 DOI: 10.1016/j.jfma.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Cases of glomerulopathy after COVID-19 vaccination have been reported in the adult population, while only a few cases have been reported in children and adolescents. For better understanding of this association in pediatric population, we aimed to describe clinical course of patients with glomerulopathy within 60 days of COVID-19 vaccination who were under followed up in the pediatric nephrology department of National Taiwan University Children's Hospital. METHODS We reviewed the clinical characteristics, vaccine types, and outcomes of patients with newly diagnosed glomerular diseases or relapse of underlying glomerulopathy within 60 days after COVID-19 vaccination at our facility between January 2021 and July 2022. RESULTS Thirteen pediatric patients were found to have newly diagnosed glomerular diseases or relapse from their underlying glomerulopathy after receiving their first, second, or third COVID-19 vaccines in our facility. Of the five pediatric patients with newly diagnosed glomerulopathy after vaccination, thin basement membrane nephropathy, idiopathic nephrotic syndrome, and hematuria have been identified. Seven patients had relapse episodes of underlying nephrotic syndrome and one patient with underlying isolated microscopic hematuria developed subnephrotic proteinuria after COVID-19 vaccination. All patients experienced remission or improvement with either immunosuppressive or conservative treatment during the follow-up period. CONCLUSIONS This is the largest case series to date of pediatric glomerulopathy after COVID-19 vaccination. From our report, patients with either newly diagnosed or relapse of glomerulopathy after vaccination had good outcomes, and receiving vaccination to prevent COVID-19 infection or complications should be encouraged in pandemic era under close monitoring kidney manifestations.
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Affiliation(s)
- Gwo-Tsann Chuang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Wei-Chou Lin
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - I-Jung Tsai
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Yong-Kwei Tsau
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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11
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Vudathaneni VKP, Nadella SB, Hema D, Boyapati R. Renal Complications Following COVID-19 Vaccination: A Narrative Literature Review. Indian J Community Med 2023; 48:214-219. [PMID: 37323744 PMCID: PMC10263038 DOI: 10.4103/ijcm.ijcm_654_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/13/2023] [Indexed: 06/17/2023] Open
Abstract
Background Renal complications have previously been reported with various vaccinations, including those for influenza and hepatitis. On a similar note, a spectrum of nephrological complications, both de novo, and flare-ups, were reported after immunization with various coronavirus disease 2019 (COVID-19) vaccines, causing concerns among patients as well as physicians. Materials and Methods A systematic search of the literature published on renal complications seen post-COVID-19 vaccination was performed up to April 2022 using electronic databases such as PubMed and Google Scholar. Result Immunoglobulin A (IgA) nephropathy, minimal change disease, glomerulonephritis, acute kidney injury, nephrotic syndrome, and anti-neutrophil cytoplasmic antibody-associated vasculitis were some of the renal complications reported upon administration of COVID-19 vaccines. The causality and underlying pathogenic mechanisms linking these complications and COVID-19 vaccination remain unclear. Nonetheless, a temporal relationship has been established with dysregulated T-cell response, transient systemic pro-inflammatory cytokine response, molecular mimicry, delayed hypersensitivity reaction to the vaccine, and other mechanisms such as hyperresponsive IgA, dysregulation of neutrophil extracellular traps were hypothesized as the possible mechanisms linking renal complications and COVID-19 vaccination. Conclusion This review emphasizes the need for rigorous surveillance and reporting of the adverse events following COVID-19 vaccination and explores the underlying mechanisms instigating these renal complications in individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
| | | | - Duddukuri Hema
- Mamata Dental College, Giriprasad Nagar Colony, Khammam, Telangana, India
| | - Ramanarayana Boyapati
- Department of Periodontology, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
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12
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Waldman M, Sinaii N, Lerma EV, Kurien AA, Jhaveri KD, Uppal NN, Wanchoo R, Avasare R, Zuckerman JE, Liew A, Gallan AJ, El-Meanawy A, Yagil Y, Lebedev L, Baskaran K, Vilayur E, Cohen A, Weerasinghe N, Petrakis I, Stylianou K, Gakiopoulou H, Hamilton AJ, Edney N, Millner R, Marinaki S, Rein JL, Killen JP, Rodríguez Chagolla JM, Bassil C, Lopez del Valle R, Evans J, Urisman A, Zawaideh M, Baxi PV, Rodby R, Vankalakunti M, Mejia Vilet JM, Ramirez Andrade SE, Homan MP, Vásquez Jiménez E, Perinpanayagam N, Velez JCQ, Mohamed MM, Mohammed KM, Sekar A, Ollila L, Aron AW, Arellano Arteaga KJ, Islam M, Berrio EM, Maoujoud O, Morales RR, Seipp R, Schulze CE, Yenchek RH, Vancea I, Muneeb M, Howard L, Caza TN. COVID-19 Vaccination and New Onset Glomerular Disease: Results from the IRocGN2 International Registry. KIDNEY360 2023; 4:349-362. [PMID: 36996301 PMCID: PMC10103269 DOI: 10.34067/kid.0006832022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Key Points IgAN and MCD are the most common de novo glomerular diseases reported after COVID-19 vaccination, particularly after mRNA vaccination. Membranous nephropathy, pauci-immune GN, and collapsing GN have also been attributed to COVID-19 vaccination, some with dual histologies. Recovery of kidney function and proteinuria remission is more likely in IgAN and MCD by 4–6 months compared with the other glomerular diseases. Background Patients with de novo glomerular disease (GD) with various renal histologies have been reported after vaccination against SARS-CoV-2. Causality has not been established, and the long-term outcomes are not known. To better characterize the GDs and clinical courses/outcomes, we created the International Registry of COVID-19 vaccination and Glomerulonephritis to study in aggregate patients with de novo GN suspected after COVID-19 vaccine exposure. Methods A REDCap survey was used for anonymized data collection. Detailed information on vaccination type and timing and GD histology were recorded in the registry. We collected serial information on laboratory values (before and after vaccination and during follow-up), treatments, and kidney-related outcomes. Results Ninety-eight patients with GD were entered into the registry over 11 months from 44 centers throughout the world. Median follow-up was 89 days after diagnosis. IgA nephropathy (IgAN) and minimal change disease (MCD) were the most common kidney diseases reported. Recovery of kidney function and remission of proteinuria were more likely in IgAN and MCD at 4–6 months than with pauci-immune GN/vasculitis and membranous nephropathy. Conclusions The development of GD after vaccination against SARS-CoV-2 may be a very rare adverse event. Temporal association is present for IgAN and MCD, but causality is not firmly established. Kidney outcomes for IgAN and MCD are favorable. No changes in vaccination risk-benefit assessment are recommended based on these findings.
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Affiliation(s)
- Meryl Waldman
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Edgar V. Lerma
- University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Nupur N. Uppal
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rupali Avasare
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jonathan E. Zuckerman
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Adrian Liew
- The Kidney and Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | | | - Ashraf El-Meanawy
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yoram Yagil
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Larissa Lebedev
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Krishoban Baskaran
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan,New South Wales, Australia
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Adrienne Cohen
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nethmi Weerasinghe
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Ioannis Petrakis
- Department of Nephrology, General University Hospital of Heraklion, Crete, Greece
| | | | | | - Alexander J. Hamilton
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Naomi Edney
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Rachel Millner
- Department of Pediatrics, Pediatric Nephrology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece
| | - Joshua L. Rein
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Paul Killen
- Department of Nephrology, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | | | - Claude Bassil
- Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida
- Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | - Jordan Evans
- Department of Nephrology, David Grant Medical Center, Travis Air Force Base, California
| | - Anatoly Urisman
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Mona Zawaideh
- Division of Pediatric Nephrology, Peyton Manning Children's Hospital, Indianapolis, Indiana
| | - Pravir V. Baxi
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | - Roger Rodby
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | | | - Juan M. Mejia Vilet
- Department of Nephrology, Instituto Nacional de Ciencas Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Silvia E. Ramirez Andrade
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Mal P. Homan
- Division of Nephrology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | | | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Muner M.B. Mohamed
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Arjun Sekar
- Rochester General Hospital, Rochester, New York
| | - Laura Ollila
- Helsinki University Central Hospital, Helsinki, Finland
| | - Abraham W. Aron
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin Javier Arellano Arteaga
- Internal Medicine Department, Nuevo Hospital Civil De Guadalajara Dr. Juan I Menchaca, Guadalajara, Mexico; Department of Clinical Medicine, University Center for Health Science, University of Guadalajara
| | - Mahmud Islam
- Division of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Esperanza Moral Berrio
- Department of Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Omar Maoujoud
- Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | | | - Carl E. Schulze
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Robert H. Yenchek
- Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Irina Vancea
- Southern Colorado Nephrology Associates, Pueblo, Colorado
| | | | - Lilian Howard
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Thammathiwat T, Chompuk L, Worawichawong S, Boonpucknavig V, Sirilak S, Pongcharoen S, Pichitsiri W, Kanjanabuch T. Membranous Nephropathy following Full-Dose of Inactivated SARS-CoV-2 Virus Vaccination: A Case Report and Literature Review. Vaccines (Basel) 2022; 11:vaccines11010080. [PMID: 36679925 PMCID: PMC9864915 DOI: 10.3390/vaccines11010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Vaccination against the SARS-CoV-2 virus (COVID-19) has proven to be the most effective measure to prevent the spread and reduce infection severity. A case report of de novo membranous nephropathy (MN) following immunization with inactivated virus vaccine (CoronaVac®, Sinovac Biotech) is presented here. A 53-year-old man presented with a sudden onset of leg edema a week after receiving an inactivated virus vaccine and a relapse of nephrotic syndrome (NS) with acute kidney injury (AKI) after a booster dose. Screening for serum anti-phospholipase A2 receptor antibody and secondary causes of MN were negative. Kidney biopsy revealed an early MN pattern with focal spike formation, whilst numerous subepithelial electron-dense deposits and a few small deposits in the mesangial area were observed through electron microscopy. A short course of steroids and oral cyclophosphamide was prescribed, resulting in the complete remission of NS and AKI. MN following SARS-CoV-2 vaccination should call for medical importance. Awareness of the association between vaccination and MN should be kept in mind to avoid unnecessary treatment with long-term immunosuppressive agents.
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Affiliation(s)
- Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Laor Chompuk
- Department of Pathology, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Suchin Worawichawong
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Supinda Sirilak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Sutatip Pongcharoen
- Division of Immunology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
- Correspondence: (S.P.); (W.P.); Tel.: +66-55965105 (S.P.); +66-55965105 (W.P.)
| | - Watchara Pichitsiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
- Correspondence: (S.P.); (W.P.); Tel.: +66-55965105 (S.P.); +66-55965105 (W.P.)
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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14
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Luo H, Li X, Ren Q, Zhou Y, Chen G, Zhao B, Li X. Acute kidney injury after COVID-19 vaccines: a real-world study. Ren Fail 2022; 44:958-965. [PMID: 35678258 PMCID: PMC9196826 DOI: 10.1080/0886022x.2022.2081180] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Acute kidney injury (AKI), a rare adverse event, cannot be ignored as millions of doses of coronavirus disease 2019 (COVID-19) vaccinations. We aimed to investigate the occurrence of post-vaccine AKI reported to the Vaccine Adverse Event Reporting System (VAERS). Methods After data mapping from December 2020 to June 2021, we summarized demographic and clinical features and outcomes of reported cases from three vaccines (Pfizer-BNT, MODERNA, and JANSSEN). The Bayesian and nonproportional analyses explored the correlations between COVID-19 vaccines and AKI. Results We identified 1133 AKI cases. Pfizer-BNT appeared to have a stronger AKI correlation than MODERNA and JANSSEN, based on the highest reporting odds ratio (ROR = 2.15, 95% confidence interval = 1.97, 2.36). We observed the differences in ages, comorbidities, current illnesses, post-vaccine AKI causes, and time to AKI onset (all p<.05) among three vaccines. Most patients are elderly, with the highest age in MODERNA (68.41 years) and lowest in JANSSEN (59.75 years). Comorbidities were noticed in 58.83% of the cases and active infections in over 20% of cases. The leading cause of post-vaccine AKI was volume depletion (40.78%), followed by sepsis (11.74%). Patients in Pfizer-BNT had the worst outcome with 19.78% deaths, following 17.78% in MODERNA and 12.36% in JANSSEN (p = .217). The proportion of patients on dialysis was higher in JANSSEN than in Pfizer-BNT and MODERNA (14.61% vs. 6.54%, 10.62%, p = .008). Conclusion AKI could occur after the COVID-19 vaccines, predominantly in elderly patients. However, the causality needs further identification.
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Affiliation(s)
- Huiting Luo
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolin Li
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qidong Ren
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangzhong Zhou
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Gang Chen
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Zhao
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Li
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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15
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Ma Q, Ma W, Song TZ, Wu Z, Liu Z, Hu Z, Han JB, Xu L, Zeng B, Wang B, Sun Y, Yu DD, Wu Q, Yao YG, Zheng YT, Wang X. Single-nucleus transcriptomic profiling of multiple organs in a rhesus macaque model of SARS-CoV-2 infection. Zool Res 2022; 43:1041-1062. [PMID: 36349357 PMCID: PMC9700497 DOI: 10.24272/j.issn.2095-8137.2022.443] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes diverse clinical manifestations and tissue injuries in multiple organs. However, cellular and molecular understanding of SARS-CoV-2 infection-associated pathology and immune defense features in different organs remains incomplete. Here, we profiled approximately 77 000 single-nucleus transcriptomes of the lung, liver, kidney, and cerebral cortex in rhesus macaques ( Macaca mulatta) infected with SARS-CoV-2 and healthy controls. Integrated analysis of the multi-organ dataset suggested that the liver harbored the strongest global transcriptional alterations. We observed prominent impairment in lung epithelial cells, especially in AT2 and ciliated cells, and evident signs of fibrosis in fibroblasts. These lung injury characteristics are similar to those reported in patients with coronavirus disease 2019 (COVID-19). Furthermore, we found suppressed MHC class I/II molecular activity in the lung, inflammatory response in the liver, and activation of the kynurenine pathway, which induced the development of an immunosuppressive microenvironment. Analysis of the kidney dataset highlighted tropism of tubule cells to SARS-CoV-2, and we found membranous nephropathy (an autoimmune disease) caused by podocyte dysregulation. In addition, we identified the pathological states of astrocytes and oligodendrocytes in the cerebral cortex, providing molecular insights into COVID-19-related neurological implications. Overall, our multi-organ single-nucleus transcriptomic survey of SARS-CoV-2-infected rhesus macaques broadens our understanding of disease features and antiviral immune defects caused by SARS-CoV-2 infection, which may facilitate the development of therapeutic interventions for COVID-19.
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Affiliation(s)
- Qiang Ma
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wenji Ma
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Tian-Zhang Song
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Zhaobo Wu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Zeyuan Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Zhenxiang Hu
- LivzonBio, Inc., Zhuhai, Guangdong 519045, China
| | - Jian-Bao Han
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Ling Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Bo Zeng
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Bosong Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Yinuo Sun
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Dan-Dan Yu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Qian Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Yong-Gang Yao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China. E-mail:
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
- Kunming National High-Level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China. E-mail:
| | - Xiaoqun Wang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
- Advanced Innovation Center for Human Brain Protection, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China. E-mail:
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16
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Baker R, Gosalia K, Jhaveri KD, Gudsoorkar P. Acute kidney injury (AKI) post-mRNA SARS-CoV-2 vaccine in patients with cancer, treated with immune check point inhibitor (ICPi): An immune double whammy! JOURNAL OF ONCO-NEPHROLOGY 2022. [PMCID: PMC9659701 DOI: 10.1177/23993693221135222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Immune check point inhibitors (ICPi) have become the first line treatment for
most of the cancers and have shown promising results. However, they can
provoke reactions, the most feared being immune related adverse events
(irAE). Case presentation: We present a series of three cases, of patients recieving ICPi. All three
patients developed AKI after administration of SARS-CoV-2 mRNA vaccine. Two
patients had kidney-biopsy-proven acute interstitial nephritis (AIN) which
responded to ICPi discontinuation and treatment with steroids. One had
presumed AIN based on the high levels of CRP and urine retinol binding
protein to creatinine ratio and responded to cessation of ICPi alone. Conclusion: These three cases demonstrate that a strong immune response from the
SARS-CoV-2 mRNA vaccine combined with an uninhibited immune system under
influence of ICPi led to an amplification of autoimmunity leading to AKI
presenting as AIN.
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Affiliation(s)
| | - Kinjal Gosalia
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Prakash Gudsoorkar
- University of Cincinnati College of Medicine, USA
- Division of Nephrology, Kidney Clinical Advancement, Research & Education (C.A.R.E.) Program, University of Cincinnati, Ohio, USA
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17
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Renal Side Effects of COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10111783. [PMID: 36366292 PMCID: PMC9696189 DOI: 10.3390/vaccines10111783] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022] Open
Abstract
Background: The COVID-19 pandemic has imposed a challenge on global healthcare and has tremendously impacted everyone's lives. Vaccination is one of the most effective and vital strategies to halt the pandemic. However, new-onset and relapsed kidney diseases have been reported after COVID-19 vaccination. This narrative review was conducted to collect published data and generalize some hypotheses for the pathogenesis of renal side effects of COVID-19 vaccines. Methods: A systematic literature search of articles reporting renal adverse reactions, including in adults and children, in the PubMed and Web of Science databases until August 2022 was performed. Results: A total of 130 cases reporting a renal adverse reaction following COVID-19 vaccination from 90 articles were included in this review, of which 90 (69%) were new-onset kidney diseases, while 40 (31%) were relapsed kidney diseases. The most frequent renal side effects of COVID-19 vaccination were minimal change disease (52 cases), IgA nephropathy (48 cases), antineutrophil cytoplasmic autoantibody vasculitis (16 cases), and acute interstitial nephritis (12 cases). Other renal side effects occurred at a much lower frequency. Follow-up data were available for 105 patients, and 100 patients (95%) responded to the treatments. Conclusions: The number of reported cases is far less than the hundreds of millions of vaccinations, and the benefit of COVID-19 vaccination far outweighs its risks. This review will assist healthcare professionals, particularly nephrologists, who should be aware of these side effects and recognize them early and treat them efficiently.
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18
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Awan MH, Samreen S, Salim B, Gul H, Perveen S, Nasim A. Corona Virus Disease-19 Vaccine-associated Autoimmune Disorders. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:111-119. [PMID: 36788969 PMCID: PMC9895874 DOI: 10.2478/rir-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 02/16/2023]
Abstract
Coronavirus disease is a highly infectious viral disease caused by severe acute respiratory syndrome virus (SARS nCoV2). It was declared a pandemic within a few months of identification of its index case. The spread of COVID-19 across the globe was rampant, overwhelming healthcare systems and crippling global economies. Since the world was caught off guard by the pandemic, vaccine programs had to be rolled out in emergency to curb its spread. Ten vaccines have been granted Emergency Use Authorization thus far. Much of the side effects we know today are post-marketing adverse effects. Most of them are mild like myalgia and injection-site reactions, but a few of them such as post-vaccination autoimmune diseases have alerted the medical community. These include vaccine-induced thrombotic thrombocytopenia, autoimmune hepatitis, myocarditis, and Graves' disease. We attempt to summarize the diverse autoimmune phenomena reported after COVID-19 vaccination, with an aim to sensitize the medical community so that they can be better equipped in management when confronted with these diseases. This review by no means refutes the potential benefit of COVID-19 vaccination which has consolidated its place in preventing infections and substantially reducing severity and mortality.
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Affiliation(s)
- Marriam Hussain Awan
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Saba Samreen
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Babur Salim
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Haris Gul
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Shahida Perveen
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amjad Nasim
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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19
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Rodríguez Y, Rojas M, Beltrán S, Polo F, Camacho-Domínguez L, Morales SD, Gershwin ME, Anaya JM. Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review. J Autoimmun 2022; 132:102898. [PMID: 36041291 PMCID: PMC9399140 DOI: 10.1016/j.jaut.2022.102898] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022]
Abstract
Autoimmunity linked to COVID-19 immunization has been recorded throughout the pandemic. Herein we present six new patients who experienced relapses of previous autoimmune disease (AD) or developed a new autoimmune or autoinflammatory condition following vaccination. In addition, we documented additional cases through a systematic review of the literature up to August 1st, 2022, in which 464 studies (928 cases) were included. The majority of patients (53.6%) were women, with a median age of 48 years (IQR: 34 to 66). The median period between immunization and the start of symptoms was eight days (IQR: 3 to 14). New-onset conditions were observed in 81.5% (n: 756) of the cases. The most common diseases associated with new-onset events following vaccination were immune thrombocytopenia, myocarditis, and Guillain-Barré syndrome. In contrast, immune thrombocytopenia, psoriasis, IgA nephropathy, and systemic lupus erythematosus were the most common illnesses associated with relapsing episodes (18.5%, n: 172). The first dosage was linked with new-onset events (69.8% vs. 59.3%, P = 0.0100), whereas the second dose was related to relapsing disease (29.5% vs. 59.3%, P = 0.0159). New-onset conditions and relapsing diseases were more common in women (51.5% and 62.9%, respectively; P = 0.0081). The groups were evenly balanced in age. No deaths were recorded after the disease relapsed, while 4.7% of patients with new-onset conditions died (P = 0.0013). In conclusion, there may be an association between COVID-19 vaccination and autoimmune and inflammatory diseases. Some ADs seem to be more common than others. Vaccines and SARS-CoV-2 may induce autoimmunity through similar mechanisms. Large, well-controlled studies are warranted to validate this relationship and assess additional variables such as genetic and other environmental factors.
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Affiliation(s)
- Yhojan Rodríguez
- Clínica del Occidente, Bogota, Colombia; Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Santiago Beltrán
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Fernando Polo
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - Laura Camacho-Domínguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Samuel David Morales
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States
| | - Juan-Manuel Anaya
- Clínica del Occidente, Bogota, Colombia; LifeFactors, Rionegro, Colombia.
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20
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Rysava R, Peiskerova M, Tesar V, Benes J, Kment M, Szilágyi Á, Csuka D, Prohászka Z. Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report. Front Immunol 2022; 13:1001366. [PMID: 36275662 PMCID: PMC9580272 DOI: 10.3389/fimmu.2022.1001366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS), also called complement-mediated hemolytic uremic syndrome (CM-HUS), is a rare disease caused by dysregulation in the alternative complement activation pathway. It is a life-threatening condition causing ischemia of a number of organs, and it typically causes acute kidney injury. This disorder may be triggered by various factors including viral or bacterial infections, pregnancy, surgery, and injuries. In about 60% of cases, the genetic origin of the disease can be identified—commonly mutations affecting complementary factor H and MCP protein. Eculizumab, a monoclonal antibody to the C5 component of the complement, represents the current effective treatment.We describe a case of a young woman with a previous history of polyvalent allergies, who developed atypical hemolytic uremic syndrome after vaccination with mRNA vaccine against SARS-CoV-2. The disease manifested by scleral bleeding, acute renal insufficiency, anemia, and thrombocytopenia. The patient was treated with plasma exchanges without sufficient effect; remission occurred only after starting treatment with eculizumab. Genetic examination showed that the patient is a carrier of multiple inherited risk factors (a rare pathogenic variant in CFH, MCPggaac haplotype of the CD46 gene, and the risk haplotype CFH H3). The patient is currently in hematological remission with persistent mild renal insufficiency, continuing treatment with eculizumab/ravulizumab. By this case report, we meant to point out the need for careful monitoring of people after vaccination, as it may trigger immune-mediated diseases, especially in those with predisposing factors.
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Affiliation(s)
- Romana Rysava
- Department of Nephrology, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia
- *Correspondence: Romana Rysava, ; Zoltán Prohászka,
| | - Martina Peiskerova
- Department of Nephrology, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia
| | - Jan Benes
- University Hospital, Charles University – Faculty of Medicine, Hradec Králové, Czechia
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, Jana Evangelisty (JE) Purkinje University, Ústi nad Labem, Czechia
| | - Martin Kment
- Department of Clinical and Transplant Pathology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Ágnes Szilágyi
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Eotvos Lorand Research Network (Office for Supported Research Groups), Semmelweis University, Budapest, Hungary
| | - Dorottya Csuka
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Eotvos Lorand Research Network (Office for Supported Research Groups), Semmelweis University, Budapest, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Eotvos Lorand Research Network (Office for Supported Research Groups), Semmelweis University, Budapest, Hungary
- *Correspondence: Romana Rysava, ; Zoltán Prohászka,
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21
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New-Onset and Relapsed Membranous Nephropathy post SARS-CoV-2 and COVID-19 Vaccination. Viruses 2022; 14:v14102143. [PMID: 36298697 PMCID: PMC9611660 DOI: 10.3390/v14102143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 12/02/2022] Open
Abstract
Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and COVID-19 vaccination, new-onset and relapsed clinical cases of membranous nephropathy (MN) have been reported. However, their clinical characteristics and pathogenesis remained unclear. In this article, we collected five cases of MN associated with SARS-CoV-2 infection and 37 related to COVID-19 vaccination. Of these five cases, four (4/5, 80%) had acute kidney injury (AKI) at disease onset. Phospholipase A2 receptor (PLA2R) in kidney tissue was negative in three (3/5, 60%) patients, and no deposition of virus particles was measured among all patients. Conventional immunosuppressive drugs could induce disease remission. The underlying pathogenesis included the subepithelial deposition of viral antigens and aberrant immune response. New-onset and relapsed MN after COVID-19 vaccination generally occurred within two weeks after the second dose of vaccine. Almost 27% of patients (10/37) suffered from AKI. In total, 11 of 14 cases showed positive for PLA2R, and 20 of 26 (76.9%) presented with an elevated serum phospholipase A2 receptor antibody (PLA2R-Ab), in which 8 cases exceeded 50 RU/mL. Conventional immunosuppressive medications combined with rituximab were found more beneficial to disease remission for relapsed patients. In contrast, new-onset patients responded to conservative treatment. Overall, most patients (24/37, 64.9%) had a favorable prognosis. Cross immunity and enhanced immune response might contribute to explaining the mechanisms of MN post COVID-19 vaccination.
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22
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Chavarot N, Padden M, Amrouche L, Malard S, Scemla A, Sberro‐Soussan R, Léon J, Legendre C, Duong JP, Zuber J, Anglicheau D, Rabant M, Isnard P. De novo posttransplant membranous nephropathy following BNT162b2 mRNA COVID-19 vaccine in a kidney transplant recipient. Am J Transplant 2022; 22:3188-3189. [PMID: 35959598 PMCID: PMC9537991 DOI: 10.1111/ajt.17166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Nathalie Chavarot
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Michael Padden
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Lucile Amrouche
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Stéphanie Malard
- Laboratoire Régional d'HistocompatibilitéSaint‐Louis Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Anne Scemla
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Rebecca Sberro‐Soussan
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Juliette Léon
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Christophe Legendre
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Jean Paul Duong
- Université de ParisParisFrance,Department of PathologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Julien Zuber
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Dany Anglicheau
- Department of Kidney and Metabolic diseasesTransplantation, and Clinical ImmunologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance,Department of ImmunologyHarvard Medical SchoolBostonMassachusettsUSA,Université de ParisParisFrance
| | - Marion Rabant
- Université de ParisParisFrance,Department of PathologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Pierre Isnard
- Université de ParisParisFrance,Department of PathologyNecker‐Enfants Malades Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
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23
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Huang W, Li B, Jiang N, Zhang F, Shi W, Zuo L, Liu S, Tang B. Impact of the COVID-19 pandemic on patients with chronic kidney disease: A narrative review. Medicine (Baltimore) 2022; 101:e29362. [PMID: 35713437 PMCID: PMC9276167 DOI: 10.1097/md.0000000000029362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT Severe acute respiratory disease coronavirus 2 is currently causing the coronavirus disease 2019 (COVID-19) pandemic, placing extreme strain on the global health system. Vaccination is the main measure for preventing the COVID-19 epidemic, especially for high-risk groups including patients with chronic kidney disease (CKD). However, CKD patients receiving dialysis or kidney transplant may be characterized by decreased renal function and immune disorders, which may have uncertainties in their health. This overview aims to introduce the possible impact of the COVID-19 vaccine on kidney disease and its application in patients with CKD to provide evidence for the COVID-19 vaccine in patients with CKD. The data for this study were collected from PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI). The following keywords were used: "COVID-19", "COVID-19 vaccine," and "CKD". The publication time of the papers was set from the establishment of the databases to September 2021. A total of 47 studies were included, and patients with CKD are a high-risk group for COVID-19 infection and severe illness. Vaccination is a powerful tool for preventing CKD patients from COVID-19. Because of possible side effects, the recurrence or deterioration of kidney disease may occur in CKD patients after vaccination. Although vaccination for patients with CKD remains a problem, with the advantages outweighing the disadvantages, stable CKD patients should complete a vaccination plan, and doctors should be aware of the recurrence or deterioration of kidney disease and close monitoring. DATA ACCESS STATEMENT Research data supporting this publication are available from the electronic databases of PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI).
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Affiliation(s)
- Wanbing Huang
- Department of Nephrology, Blood Purification Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Bohou Li
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Nan Jiang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengxia Zhang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Shi
- Department of Nephrology, The People's Hospital of Gaozhou, Maoming, Guangdong, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Bin Tang
- Department of Nephrology, Blood Purification Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
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24
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Visch R, Wetzels J, Vink C, van de Logt AE. COVID-19 vaccination in patients with membranous nephropathy. Kidney Int Rep 2022; 7:1922-1923. [PMID: 35702396 PMCID: PMC9181366 DOI: 10.1016/j.ekir.2022.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ruben Visch
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Coralien Vink
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anne-Els van de Logt
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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25
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de Seabra Rodrigues Dias IR, Cao Z, Kwok HF. Adamalysins in COVID-19 - Potential mechanisms behind exacerbating the disease. Biomed Pharmacother 2022; 150:112970. [PMID: 35658218 PMCID: PMC9010236 DOI: 10.1016/j.biopha.2022.112970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, is a current pandemic that has resulted in nearly 250 million cases and over 5 million deaths. While vaccines have been developed to prevent infection, and most COVID-19 cases end up being fairly light, there are severe cases of COVID-19 that may end up in death, even with adequate healthcare treatment. New options to combat this disease's effects, therefore, could prove to be invaluable in saving lives. Adamalysins are proteins that have several roles in regulating different functions in the human body but are also known to have functions in inflammation. They are also known to have roles in several different diseases, including COVID-19, where ADAM17, in particular, is now well-known to have a prominent role, but also several diseases which include comorbidities that may worsen cases of COVID-19. Therefore, investigating the functions of adamalysins in disease may give us clues to the molecular workings of COVID-19 as well as potentially new therapeutic targets. Understanding these molecular mechanisms may also allow for an understanding of the mechanisms behind the rare severe side effects that occur in response to current COVID-19 vaccines, which may lead to better monitoring measures for people who may be more at risk of developing these side effects. This review investigates the known roles and functions of adamalysins in disease, including what is currently known of their involvement in COVID-19, and how these functions might be involved.
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Affiliation(s)
- Ivo Ricardo de Seabra Rodrigues Dias
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Macau, Avenida de Universidade, Taipa, Macau SAR,Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida de Universidade, Taipa, Macau SAR
| | - Zhijian Cao
- State Key Laboratory of Virology and Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan 430072, Hubei, China,Co-corresponding author
| | - Hang Fai Kwok
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Macau, Avenida de Universidade, Taipa, Macau SAR,Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida de Universidade, Taipa, Macau SAR,Corresponding author at: Department of Biomedical Sciences, Faculty of Health Sciences, University of Macau, Avenida de Universidade, Taipa, Macau SAR
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26
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Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Glomerulonephritis in a 15-year-old Patient After Receiving the Second Dose of the BBIBP-CorV (Sinopharm) COVID-19 Vaccine: A Case Report. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-127124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is a group of multisystemic autoimmune diseases that can involve organs such as kidneys and respiratory tracts. Since the initiation of COVID-19 vaccines, there have been few cases of antineutrophil cytoplasmic antibody (ANCA) glomerulonephritis development after receiving vaccine doses. Case Presentation: This report describes a 15-year-old man who has developed ANCA-associated glomerulonephritis (AAGN) after receiving the second dose of BBIBP-CorV (Sinopharm) COVID-19 vaccine. Conclusions: Development of AAGN after both natural SARS-CoV-2 infection and following other vaccinations raises the question of the possible causality between the two. Considering the widespread use of COVID-19 vaccines, it is highly important to investigate their possible side effects.
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27
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Wong CKH, Lau KTK, Xiong X, Au ICH, Lai FTT, Wan EYF, Chui CSL, Li X, Chan EWY, Gao L, Cheng FWT, Tang SCW, Wong ICK. Adverse events of special interest and mortality following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines in Hong Kong: A retrospective study. PLoS Med 2022; 19:e1004018. [PMID: 35727759 PMCID: PMC9212142 DOI: 10.1371/journal.pmed.1004018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/09/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Safety monitoring of coronavirus disease 2019 (COVID-19) vaccines is crucial during mass vaccination rollout to inform the choice of vaccines and reduce vaccine hesitancy. Considering the scant evidence directly comparing the safety profiles of mRNA and inactivated SARS-CoV-2 vaccines, this territory-wide cohort study aims to compare the incidence of various adverse events of special interest (AESIs) and all-cause mortality between CoronaVac (inactivated vaccine) and BNT162b2 (mRNA-based vaccine). Our results can help vaccine recipients make an informed choice. METHODS AND FINDINGS A retrospective, population-based cohort of individuals who had received at least 1 dose of BNT162b2 or CoronaVac from 23 February to 9 September 2021 in Hong Kong, and had data linkage to the electronic medical records of the Hong Kong Hospital Authority, were included. Those who had received mixed doses were excluded. Individuals were observed from the date of vaccination (first or second dose) until mortality, second dose vaccination (for first dose analysis), 21 days after vaccination, or 30 September 2021, whichever came first. Baseline characteristics of vaccinated individuals were balanced between groups using propensity score weighting. Outcome events were AESIs and all-cause mortality recorded during 21 days of post-vaccination follow-up after each dose, except anaphylaxis, for which the observation period was restricted to 2 days after each dose. Incidence rate ratios (IRRs) of AESIs and mortality comparing between CoronaVac and BNT162b2 recipients were estimated after each dose using Poisson regression models. Among 2,333,379 vaccinated individuals aged 18 years or above, the first dose analysis included 1,308,820 BNT162b2 and 955,859 CoronaVac recipients, while the second dose analysis included 1,116,677 and 821,560 individuals, respectively. The most frequently reported AESI among CoronaVac and BNT162b2 recipients was thromboembolism (first dose: 431 and 290 per 100,000 person-years; second dose: 385 and 266 per 100,000 person-years). After the first dose, incidence rates of overall AESIs (IRR = 0.98, 95% CI 0.89-1.08, p = 0.703) and mortality (IRR = 0.96, 95% CI 0.63-1.48, p = 0.868) associated with CoronaVac were generally comparable to those for BNT162b2, except for Bell palsy (IRR = 1.95, 95% CI 1.12-3.41, p = 0.018), anaphylaxis (IRR = 0.34, 95% CI 0.14-0.79, p = 0.012), and sleeping disturbance or disorder (IRR = 0.66, 95% CI 0.49-0.89, p = 0.006). After the second dose, incidence rates of overall AESIs (IRR = 0.97, 95% CI 0.87-1.08, p = 0.545) and mortality (IRR = 0.85, 95% CI 0.51-1.40, p = 0.516) were comparable between CoronaVac and BNT162b2 recipients, with no significant differences observed for specific AESIs. The main limitations of this study include residual confounding due to its observational nature, and the possibility of its being underpowered for some AESIs with very low observed incidences. CONCLUSIONS In this study, we observed that the incidences of AESIs (cumulative incidence rate of 0.06%-0.09%) and mortality following the first and second doses of CoronaVac and BNT162b2 vaccination were very low. The safety profiles of the vaccines were generally comparable, except for a significantly higher incidence rate of Bell palsy, but lower incidence rates of anaphylaxis and sleeping disturbance or disorder, following first dose CoronaVac versus BNT162b2 vaccination. Our results could help inform the choice of inactivated COVID-19 vaccines, mainly administered in low- and middle-income countries with large populations, in comparison to the safety of mRNA vaccines. Long-term surveillance on the safety profile of COVID-19 vaccines should continue.
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Affiliation(s)
- Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
| | - Kristy Tsz Kwan Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Ivan Chi Ho Au
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Franco Wing Tak Cheng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Sydney Chi Wai Tang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Parks, Hong Kong SAR, China
- Centre for Medicines Optimisation Research and Education, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom
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New-Onset Acute Kidney Disease Post COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10050742. [PMID: 35632497 PMCID: PMC9147880 DOI: 10.3390/vaccines10050742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an exceptional setback to the global economy and health. Vaccination is one of the most effective interventions to markedly decrease severe illness and death from COVID-19. In recent years, there have been increasingly more reports of new acute kidney injury (AKI) after COVID-19 vaccination. Podocyte injury, IgA nephropathy, vasculitis, tubulointerstitial injury, and thrombotic microangiopathy appear to be the main pathological phenotypes. Nonetheless, whether the link between the COVID-19 vaccine and acute kidney disease (AKD) is causal or coincidental remains to be verified. Here, we generalize some hypotheses for the emergence of AKD and its pathogenesis in response to certain COVID-19 vaccines. In fact, the enormous benefits of mass vaccination against COVID-19 in preventing COVID-19 morbidity and mortality cannot be denied. The purpose of this review is to assist in the clinical assessment and management of AKD following COVID-19 vaccination.
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Ritter A, Helmchen B, Gaspert A, Bleisch J, Fritschi B, Buchkremer F, Damm S, Schmid N, Schachtner T, Seeger H. Clinical spectrum of gross haematuria following SARS-CoV-2 vaccination with mRNA vaccines. Clin Kidney J 2022; 15:961-973. [PMID: 35498904 PMCID: PMC9050541 DOI: 10.1093/ckj/sfab284] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Novel messenger RNA (mRNA)-based vaccines play an important role in current vaccination campaigns against SARS-CoV-2. They are highly efficacious and generally well tolerated. Vaccination in patients with immune-mediated kidney diseases is recommended. A number of cases with de novo or relapsing glomerulonephritis shortly after vaccine application have been reported, some of which presented with gross haematuria. Methods We collected 10 cases of macrohaematuria following mRNA-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination at our tertiary care institution and referring centres. Additionally, we pooled all 25 published cases from the literature with ours to analyse their clinical characteristics. Results Most macrohaematuria episodes (72.2%) began within 2 days after vaccination, the majority after the second dose. In some individuals, repeated episodes occurred after subsequent doses of the same vaccine. A total of 65.7% of patients never had macrohaematuria before. A total of 45.7% were known to suffer from immunoglobulin A nephropathy (IgAN); the rest had no prior renal diagnosis. IgAN was the most frequent new diagnosis, but anti-neutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane disease were also identified. Acute kidney injury (AKI) occurred in 28.6% of patients, with an increase in serum creatinine not meeting Kidney Disease: Improving Global Outcomes AKI criteria in 28.6%. Treatment ranged from conservative management, renin-angiotensin-aldosterone system inhibitors, steroids and cyclophosphamide to plasmapheresis. While renal outcomes were mainly favourable in isolated IgAN, they were poor in patients with additional or isolated small vessel vasculitis. Conclusion Awareness of gross haematuria after SARS-CoV-2 vaccination is important. Close follow-up and additional work up, particularly in individuals without known underlying kidney disease or worsening renal function, is essential. For patients with vaccine-associated macrohaematuria, an alternative vaccine class might be considered for subsequent vaccinations.
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Affiliation(s)
- Alexander Ritter
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Helmchen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Joerg Bleisch
- Division of Nephrology, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Barbara Fritschi
- Nephrocare, Nieren- und Dialysezentrum Männedorf AG, Männedorf, Switzerland
| | | | - Stephanie Damm
- Division of Nephrology, Cantonal Hospital Zug, Zug, Switzerland
| | - Nicolas Schmid
- Division of Nephrology, City Hospital Zurich Waid, Zurich, Switzerland
| | - Thomas Schachtner
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
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30
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Chen G, Ren Q, Zhou J, Zhou Y, Luo H, Wang Y, Li X, Zhao B, Li X. Association of Current Active Illnesses and Severe Acute Kidney Injury after COVID-19 Vaccines: A Real-World Study. Vaccines (Basel) 2022; 10:vaccines10050706. [PMID: 35632462 PMCID: PMC9146963 DOI: 10.3390/vaccines10050706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
The administration of COVID-19 vaccines has become increasingly essential to curb the pandemic. However, adverse events of acute kidney injury (AKI) emerge rapidly as the COVID-19 vaccination promotes. To investigate the intervenable risk factors of AKI, we searched the Vaccine Adverse Event Reporting System database and recorded adverse effects after COVID-19 vaccines from Dec 2020 to Jun 2021. We included 1149 AKI cases, of which 627 (54.6%) cases were reported following the Pfizer-BNT COVID-19 vaccine, and 433 (37.7%) were reported after the Moderna vaccine. A univariate analysis revealed that coexisting active illnesses (infections, uncontrolled hypertension, heart failure, etc.) have an unfavorable prognosis, with an increased risk of death (OR 2.35, 95% CI 1.70−3.25, p < 0.001). The other risk factors included older age and past disease histories. An adjusted regression analysis proved that coexisting active illnesses worsen AKI prognosis after COVID-19 vaccination, with a higher mortality risk (OR 2.19, 95% CI 1.48−3.25, p < 0.001). In subgroup analysis, we stratified different variables, and none revealed a significant effect modification on the association between coexisting active illnesses and AKI-associated death after vaccination (p-interaction >0.05). We found that coexisting active illnesses could complicate AKI after vaccines, but the potential causal relationship needed further investigation.
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Affiliation(s)
- Gang Chen
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
| | - Qidong Ren
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
- School of Medicine, Tsinghua University, Beijing 100730, China
| | - Jiannan Zhou
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
- Nephrology Department, Beijing Aerospace General Hospital, Beijing 100076, China
| | - Yangzhong Zhou
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
| | - Huiting Luo
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
| | - Yining Wang
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
| | - Xiaolin Li
- Pharmacy Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (X.L.); (B.Z.)
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bin Zhao
- Pharmacy Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (X.L.); (B.Z.)
| | - Xuemei Li
- Nephrology Department, Institute of Materia Medica, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.C.); (Q.R.); (J.Z.); (Y.Z.); (H.L.); (Y.W.)
- Correspondence:
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Alhosaini MN. A Case of Minimal Change Disease after SARS-CoV-2 Vaccination under the Age of 18. Avicenna J Med 2022; 12:31-33. [PMID: 35586388 PMCID: PMC9110102 DOI: 10.1055/s-0042-1743209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
AbstractThis is a care report of a 16-year-old-male who developed de novo minimal change disease following the second dose of the Pfizer vaccine. The patient developed sudden onset edema and 10 kg weight gain. He had nephrotic range proteinuria with normal renal function. Kidney biopsy with adequate sample confirmed minimal change disease. The patient improved after 1 week of starting prednisone. This is the first case of minimal change disease after the Pfizer vaccine in the teenager population since expanding the age groups to allow younger subjects to receive the vaccine. Reporting cases at different age groups will help in trying to clarify whether the increasing reports of nephrotic syndrome following the vaccination are accidental or cause–effect relationship.
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Turner-Stokes T, Edwards H, Lightstone L. COVID-19 in patients with glomerular disease. Curr Opin Nephrol Hypertens 2022; 31:191-198. [PMID: 34923542 DOI: 10.1097/mnh.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Managing patients with glomerular disease during the COVID-19 pandemic has been challenging, as the infection risk associated with immunosuppression must be balanced against the need to control severe glomerular disease that can lead to kidney failure. This review provides an overview of COVID-19 and the effectiveness of SARS-CoV-2 vaccination in patients with glomerular disease. RECENT FINDINGS Registry data, although biased towards outcomes of hospitalized patients, suggest that the mortality from COVID-19 is higher in patients with glomerular disease than in the general population. Glucocorticoid use prior to SARS-CoV-2 infection is associated with adverse outcomes from COVID-19. Rituximab significantly attenuates serological responses to both natural infection and vaccination against SARS-CoV-2, although it is not clear whether this leads to adverse outcomes. Case reports of disease flares occurring after vaccination have been reported, but causality in any of these cases has yet to be proven and the absolute risk remains very small. SUMMARY Patients with glomerular disease represent an at-risk group for severe COVID-19 disease and vaccination is key to reducing this risk. As immunosuppressed patients demonstrate an attenuated response to vaccination, the efficacy of a third primary dose followed by a subsequent booster is being investigated.
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Affiliation(s)
- Tabitha Turner-Stokes
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Helena Edwards
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Fatima R, Gowrishankar S. Myoglobinuria-induced Acute Kidney Injury Secondary to Covishield TM Vaccination. Indian J Nephrol 2022; 32:484-487. [PMID: 36568603 PMCID: PMC9775595 DOI: 10.4103/ijn.ijn_257_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 12/27/2022] Open
Abstract
Vaccination is the best strategy for the development of herd immunity and for the control of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic. As the number of immunizations across the globe reaches a record number, random cases of diverse adverse effects of the vaccines are being documented. We report a case of renal biopsy-proven myoglobin-induced acute tubular injury requiring dialytic support post-CovishieldTM vaccination. Awareness of this rare complication is necessary so that it can be recognized early, and renal injury avoided.
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Affiliation(s)
- Rana Fatima
- Department of Nephrology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India
| | - Swarnalata Gowrishankar
- Department of Histopathology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India,Address for correspondence: Dr. Swarnalata Gowrishankar, Department of Histopathology, Apollo Hospitals, Jubilee Hills, Hyderabad - 500 096, Telangana, India. E-mail:
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Mira FS, Costa Carvalho J, de Almeida PA, Pimenta AC, Alen Coutinho I, Figueiredo C, Rodrigues L, Sousa V, Ferreira E, Pinto H, Escada L, Galvão A, Alves R. A Case of Acute Interstitial Nephritis After Two Doses of the BNT162b2 SARS-CoV-2 Vaccine. Int J Nephrol Renovasc Dis 2021; 14:421-426. [PMID: 34887676 PMCID: PMC8650829 DOI: 10.2147/ijnrd.s345898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023] Open
Abstract
Background The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine. Case Presentation We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient. Conclusion Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.
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Affiliation(s)
- Filipe S Mira
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Jóni Costa Carvalho
- Allergy and Clinical Immunology Department, Coimbra University Hospital, Coimbra, Portugal
| | | | | | - Iolanda Alen Coutinho
- Allergy and Clinical Immunology Department, Coimbra University Hospital, Coimbra, Portugal
| | | | - Luís Rodrigues
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Vítor Sousa
- Coimbra University Faculty of Medicine, Coimbra, Portugal.,Pathological Anatomy Department, Coimbra University Hospital, Coimbra, Portugal
| | - Emanuel Ferreira
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Helena Pinto
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Luís Escada
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Ana Galvão
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
| | - Rui Alves
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra University Faculty of Medicine, Coimbra, Portugal
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Psyllaki A, Stavrakaki I, Androvitsanea A, Gakiopoulou H, Petrakis I, Stylianou K. Two cases of glomerular involvement after vaccination against COVID-19: epiphenomenon or causality? Clin Kidney J 2021; 15:574-575. [PMID: 35211312 PMCID: PMC8862059 DOI: 10.1093/ckj/sfab252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anna Psyllaki
- Department of Nephrology, University of Crete, Heraklion, Crete, Greece
| | - Ioanna Stavrakaki
- Department of Nephrology, University of Crete, Heraklion, Crete, Greece
| | | | - Hariklia Gakiopoulou
- Department of Renal Pathology, National Kapodistrian University of Athens, AthensGreece
| | - Ioannis Petrakis
- Department of Nephrology, University of Crete, Heraklion, Crete, Greece
| | - Kostas Stylianou
- Department of Nephrology, University of Crete, Heraklion, Crete, Greece
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Caza TN, Cassol CA, Messias N, Hannoudi A, Haun RS, Walker PD, May RM, Seipp RM, Betchick EJ, Amin H, Ziadie MS, Haderlie M, Eduwu-okwuwa J, Vancea I, Seek M, Elashi EB, Shenoy G, Khalillullah S, Flaxenburg JA, Brandt J, Diamond MJ, Frome A, Kim EH, Schlessinger G, Ulozas E, Weatherspoon JL, Hoerschgen ET, Fabian SL, Bae SY, Iqbal B, Chouhan KK, Karam Z, Henry JT, Larsen CP. Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases. KIDNEY360 2021; 2:1770-1780. [PMID: 35372991 PMCID: PMC8785835 DOI: 10.34067/kid.0005372021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 04/17/2023]
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 patient 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 GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. Results The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient 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 with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hassan Amin
- The Kidney Group of Memphis, Memphis, Tennessee
| | | | - Michael Haderlie
- Iowa Kidney Institute, Bingham Memorial Hospital, Blackfoot, Idaho
| | | | - Irina Vancea
- Southern Colorado Nephrology Associates, Pueblo, Colorado
| | | | | | | | | | | | - John Brandt
- Division of Nephrology, University of New Mexico, Albuquerque, New Mexico
| | | | - Adam Frome
- Kidney Specialists of North Houston, Shenandoah, Texas
| | - Eugene H. Kim
- Kidney and Hypertension Specialists PLLC, Manassas, Virginia
| | | | | | | | | | | | | | - Bilal Iqbal
- Kidney Specialists of Southern Nevada, Las Vegas, Nevada
| | | | - Zeina Karam
- Mercy Clinic Nephrology, Washington, Missouri
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Gueguen L, Loheac C, Saidani N, Khatchatourian L. Membranous nephropathy following anti-COVID-19 mRNA vaccination. Kidney Int 2021; 100:1140-1141. [PMID: 34419553 PMCID: PMC8376522 DOI: 10.1016/j.kint.2021.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Lorraine Gueguen
- Department of Nephrology, Cornouaille Hospital Quimper, Quimper, France.
| | - Charlotte Loheac
- Department of Nephrology, Cornouaille Hospital Quimper, Quimper, France
| | - Nadia Saidani
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
| | - Lydie Khatchatourian
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
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38
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Li NL, Coates PT, Rovin BH. COVID-19 vaccination followed by activation of glomerular diseases: does association equal causation? Kidney Int 2021; 100:959-965. [PMID: 34534551 PMCID: PMC8437826 DOI: 10.1016/j.kint.2021.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Nicholas L Li
- Department of Internal Medicine, Division of Nephrology, Ohio State University, Columbus, Ohio, USA
| | - P Toby Coates
- Renal and Transplantation Service, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brad H Rovin
- Department of Internal Medicine, Division of Nephrology, Ohio State University, Columbus, Ohio, USA.
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39
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Wu HHL, Kalra PA, Chinnadurai R. New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review. Vaccines (Basel) 2021; 9:1252. [PMID: 34835183 PMCID: PMC8622870 DOI: 10.3390/vaccines9111252] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/17/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
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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Affiliation(s)
- Henry H. L. Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
| | - Philip A. Kalra
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance Foundation Trust, Salford M6 8HD, UK
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance Foundation Trust, Salford M6 8HD, UK
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40
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Mohseni Afshar Z, Babazadeh A, Janbakhsh A, Mansouri F, Sio TT, Sullman MJM, Carson-Chahhoud K, Hosseinzadeh R, Barary M, Ebrahimpour S. Coronavirus disease 2019 (Covid-19) vaccination recommendations in special populations and patients with existing comorbidities. Rev Med Virol 2021; 32:e2309. [PMID: 34677889 PMCID: PMC8646697 DOI: 10.1002/rmv.2309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 01/09/2023]
Abstract
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a crucial step in ending the current worldwide pandemic. However, several particularly vulnerable groups in the population were not included in sufficient numbers in coronavirus disease 2019 (Covid‐19) vaccine trials. Therefore, as science advances, the advice for vaccinating these special populations against Covid‐19 will continue to evolve. This focused review provides the latest recommendations and considerations for these special populations (i.e., patients with rheumatologic and autoimmune disorders, cancer, transplant recipients, chronic liver diseases, end‐stage renal disease, neurologic disorders, psychiatric disorders, diabetes mellitus, obesity, cardiovascular diseases, chronic obstructive pulmonary disease, human immunodeficiency virus, current smokers, pregnant and breastfeeding women, the elderly, children, and patients with allergic reactions) using the currently available research evidence.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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41
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Guo W, Tan PH, Baikunje S. Membranous nephropathy in a patient with COVID-19 infection. J Nephrol 2021; 35:351-355. [PMID: 34618335 PMCID: PMC8495448 DOI: 10.1007/s40620-021-01165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Weiwen Guo
- Department of Renal Medicine, Sengkang General Hospital, Medical Centre Level 9, 110 Sengkang E Way, Singapore, 544886, Singapore.
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Shashidhar Baikunje
- Department of Renal Medicine, Sengkang General Hospital, Medical Centre Level 9, 110 Sengkang E Way, Singapore, 544886, Singapore
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42
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Klomjit N, Alexander MP, Fervenza FC, Zoghby Z, Garg A, Hogan MC, Nasr SH, Minshar MA, Zand L. COVID-19 vaccination and glomerulonephritis. Kidney Int Rep 2021; 6:2969-2978. [PMID: 34632166 PMCID: PMC8493782 DOI: 10.1016/j.ekir.2021.09.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction mRNA COVID-19 vaccine is more effective than traditional vaccines owing to superior immune activation. Nevertheless, the impact of mRNA COVID-19 vaccine on triggering de novo/relapsing glomerulonephritis (GN) is limited. We report a case series of patients who developed new or relapsing GN postvaccination. Methods We evaluated baseline characteristics, vaccine type, and clinical outcomes of 13 patients from our institution who had a new diagnosis or relapse of their GN post–mRNA COVID-19 vaccination. Results Of 13 patients, 8 patients were newly diagnosed with having GN and 5 patients had relapse. Median age was 62 years (range 19–83 years). Autoimmune disease (38%) was the most prevalent underlying disease followed by cancer (23%). Most patients were White males. IgA nephropathy (IgAN) was the most common GN in our series (5 patients, 38%) followed by membranous nephropathy (MN) (3 patients, 23%). There was 1 patient with IgAN who had evidence of IgA deposits before vaccination suggesting the immune activation after vaccination triggered a flare of the disease. Our case series also included the first case report of tip-variant focal segmental glomerulosclerosis (FSGS), NELL-1–associated MN, and atypical anti–glomerular basement membrane (GBM) nephritis. A total of 77% developed acute kidney injury (AKI) with most being Kidney Disease: Improving Global Outcomes stage 1 (67%). Outcomes are favorable with 80% responding to therapy. Conclusion New cases and relapse of GN can present shortly after mRNA COVID-19 vaccination. New cases of IgAN may result from unmasking of undiagnosed IgAN owing to robust immune activation rather than development of new deposits.
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Affiliation(s)
- Nattawat Klomjit
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA.,Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA
| | - Mariam Priya Alexander
- Department of pathology and laboratory medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Ziad Zoghby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Arvind Garg
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Samih H Nasr
- Department of pathology and laboratory medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Marwan Abu Minshar
- Division of Nephrology and Hypertension, Essentia Health, Fargo, ND, USA
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN, USA
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43
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Bomback AS, Kudose S, D'Agati VD. De Novo and Relapsing Glomerular Diseases After COVID-19 Vaccination: What Do We Know So Far? Am J Kidney Dis 2021; 78:477-480. [PMID: 34182049 PMCID: PMC8230841 DOI: 10.1053/j.ajkd.2021.06.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Andrew S Bomback
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York.
| | - Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
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44
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Carr EJ, Kronbichler A, Graham-Brown M, Abra G, Argyropoulos C, Harper L, Lerma EV, Suri RS, Topf J, Willicombe M, Hiremath S. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6:2292-2304. [PMID: 34250319 PMCID: PMC8257418 DOI: 10.1016/j.ekir.2021.06.027] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
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Affiliation(s)
| | | | | | - Graham Abra
- Satellite Healthcare, San Jose, California, USA
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Rita S. Suri
- Research Institute, University Health Center, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Detroit, Michigan, USA
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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45
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Izzedine H, Bonilla M, Jhaveri KD. Nephrotic syndrome and vasculitis following SARS-CoV-2 vaccine: true association or circumstantial? Nephrol Dial Transplant 2021; 36:1565-1569. [PMID: 34245294 PMCID: PMC8344645 DOI: 10.1093/ndt/gfab215] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/04/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital-Ramsay Générale de Santé, Paris, France
| | - Marco Bonilla
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
- The Glomerular Disease Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Northwell Health, Great Neck, NY, USA
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46
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Masset C, Kervella D, Kandel-Aznar C, Fantou A, Blancho G, Hamidou M. Relapse of IgG4-related nephritis following mRNA COVID-19 vaccine. Kidney Int 2021; 100:465-466. [PMID: 34116086 PMCID: PMC8186934 DOI: 10.1016/j.kint.2021.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalier Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalier Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Christine Kandel-Aznar
- Laboratoire d'Anatomie et Cytologie Pathologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Fantou
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalier Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Mohamed Hamidou
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France; Service de Médecine Interne, Centre Hospitalier Universitaire de Nantes, Nantes, France
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47
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Da Y, Goh GH, Khatri P. A case of membranous nephropathy following Pfizer-BioNTech mRNA vaccination against COVID-19. Kidney Int 2021; 100:938-939. [PMID: 34332960 PMCID: PMC8321686 DOI: 10.1016/j.kint.2021.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 10/26/2022]
Affiliation(s)
- Yi Da
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore.
| | - Giap Hean Goh
- Department of Pathology, National University Hospital, Singapore
| | - Priyanka Khatri
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore; FAST and Chronic Programmes, Alexandra Hospital, Singapore
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