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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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Parikh C, Upadhyay H, Patel S, Sundararajan R, Shah D, Anand A, Baraskar B, Bhatt T, Verma D, Agrawal S, Mittal A, Gupta S. Nephrotic syndrome following COVID-19 vaccination: a systematic review. J Nephrol 2023; 36:2431-2440. [PMID: 37505405 DOI: 10.1007/s40620-023-01710-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 infection has caused significant morbidity and mortality. Vaccines produced against this virus have proven highly effective. However, adverse events following vaccination have also been reported. One of them is nephrotic syndrome, that can be associated with different pathologic pictures. This review aims to provide a wider understanding of incidence, etiopathogenesis, and management of nephrotic syndrome following vaccination against SARS-CoV-2. METHODS AND RESULTS A literature search was undertaken using appropriate keywords in various databases like PubMed, Google Scholar, Europe PMC, and Science Direct. Twenty-one articles were included following qualitative assessment. Data of 74 patients from these articles were included. DISCUSSION The pathogenesis of nephrotic syndrome following COVID vaccination has been widely attributed to the activation of angiotensin-converting enzyme-2 receptors, leading to podocyte effacement. Relapses have also been reported in patients with prior history of nephrotic syndrome following COVID-19 vaccination. A renal biopsy is necessary to identify the histopathological picture. Management of COVID-19 vaccine-induced nephrotic syndrome was mainly reported as successfully attainable with corticosteroids and supportive management. CONCLUSION Further investigations will help in establishing an early diagnosis and salvaging kidney function.
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Affiliation(s)
- Charmy Parikh
- Pramukhswami Medical College, Anand, Gujarat, India.
- Carle BroMenn Medical Center, Normal, Illinois, USA.
| | | | - Suyog Patel
- B.J. Medical College, Ahmedabad, Gujarat, India
| | - Ramaswamy Sundararajan
- JSS Medical College (JSS Academy of Higher Education and Research), Mysore, Karnataka, India
| | | | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bhavana Baraskar
- Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Tulsi Bhatt
- Pramukhswami Medical College, Anand, Gujarat, India
| | | | | | - Amol Mittal
- Westchester Medical Center, Valhalla, USA
- New York Medical College, Valhalla, USA
| | - Sanjeev Gupta
- Westchester Medical Center, Valhalla, USA
- New York Medical College, Valhalla, USA
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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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Hishida E, Ono Y, Oe K, Imai T, Yoshizawa H, Nakaya T, Kawata H, Akimoto T, Saito O, Nagata D. Acute Interstitial Nephritis with Glomerular Capillary IgA Deposition Following SARS-CoV-2 mRNA Vaccination. Intern Med 2023; 62:2381-2387. [PMID: 37587055 PMCID: PMC10484757 DOI: 10.2169/internalmedicine.1631-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/20/2023] [Indexed: 08/18/2023] Open
Abstract
We herein report a case of acute kidney injury (AKI) presenting as acute interstitial nephritis (AIN) after the first dose of the BNT162b2 mRNA vaccine against coronavirus disease 2019 (COVID-19). A 69-year-old man with a history of diabetes and hypertension presented with AKI 4 days after receiving the vaccine. Despite the administration of methylprednisolone pulse treatment, his renal function worsened, which prompted us to initiate temporal hemodialysis. His renal function subsequently improved, and a renal biopsy confirmed AIN and glomerular capillary IgA deposition without apparent crescents. The clinical history and histological findings suggest a relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and AIN as a rare side effect.
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Affiliation(s)
- Erika Hishida
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Yuko Ono
- Department of Diagnostic Pathology, Dokkyo Medical University, Japan
| | - Kazuho Oe
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Hiromichi Yoshizawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Takeo Nakaya
- Department of Pathology, Jichi Medical University, Japan
| | | | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
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5
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Boyle T, O'Lone E, Phua E, Anderson J, Mather A, Fernando SL. Subsequent COVID-19 Prophylaxis in COVID-19 Associated Glomerulopathies. Vaccines (Basel) 2023; 11:1152. [PMID: 37514968 PMCID: PMC10385225 DOI: 10.3390/vaccines11071152] [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: 05/12/2023] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Successful vaccination has been the decisive factor in the overall decline of SARS-CoV2 infection related morbidity and mortality. However, global effects of the COVID-19 pandemic are ongoing, with reports of glomerular disease occurring in relation to both infection and vaccination. A particular rise in anti-GBM disease has been identified. Information is still emerging regarding the optimal management of such cases. We reviewed anti-GBM antibody detection rates at our test center over the past 5 years. We followed three patients with biopsy confirmed glomerular disease temporally related to COVID-19 vaccination. Each patient proceeded to receive subsequent COVID-19 vaccination as per immunologist recommendations. Further assessment included COVID-19 antibody testing in each case. A three-fold increase in significant anti-GBM antibody results noted at our center was associated with COVID infection in 10% of cases, and COVID vaccination in 25% of cases. We demonstrated that subsequent vaccination did not appear to lead to adverse effects including relapse in our three cases of COVID-19 vaccine-associated GN. We also identified positive COVID-19 antibody levels in two out of three cases, despite immunosuppression. We report a rise in anti-GBM antibody disease incidence. Our small study suggests that COVID-19 antibody testing can help determine COVID prophylaxis requirements, and subsequent vaccination with an alternative vaccine type appears safe.
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Affiliation(s)
- Therese Boyle
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
| | - Emma O'Lone
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Elaine Phua
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Janet Anderson
- Immunology Laboratory, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Amanda Mather
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Immunology Laboratory, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
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Horinouchi T, Ueda C, Kitakado H, Yoshikawa N, Nozu K. Steroid resistant nephrotic syndrome with collapsing focal segmental glomerulosclerosis in a 12-year-old Japanese female after SARS-CoV-2 vaccination. J Nephrol 2023; 36:1435-1438. [PMID: 36795315 PMCID: PMC9933812 DOI: 10.1007/s40620-023-01577-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/01/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Tomoko Horinouchi
- Department of Pediatrics, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
| | - Chika Ueda
- Department of Pediatrics, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Hideaki Kitakado
- Department of Pediatrics, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Kandai Nozu
- Department of Pediatrics, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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7
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Chen CC, Yang SS, Hsu YJ, Sung CC, Chu P, Wu CC, Hsu SN, Wang HE, Lee DJ, Lin SH. Acute kidney disease following COVID-19 vaccination: a single-center retrospective study. Front Med (Lausanne) 2023; 10:1189243. [PMID: 37283622 PMCID: PMC10239839 DOI: 10.3389/fmed.2023.1189243] [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: 03/18/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background Rare cases of de novo or relapsed kidney diseases associated with vaccination against coronavirus disease 2019 (COVID-19) have been increasingly reported. The aim of this study was to report the incidence, etiologies, and outcomes of acute kidney disease (AKD) following COVID-19 vaccination. Methods This retrospective study extracted cases from renal registry of a single medical center from 1 March 2021 to 30 April 2022, prior to the significant surge in cases of the Omicron variant of COVID-19 infection in Taiwan. Adult patients who developed AKD after COVID-19 vaccination were included. We utilized the Naranjo score as a causality assessment tool for adverse vaccination reactions and charts review by peer nephrologists to exclude other causes. The etiologies, characteristics, and outcomes of AKD were examined. Results Twenty-seven patients (aged 23 to 80 years) with AKD were identified from 1,897 vaccines (estimated rate of 13.6 per 1000 patient-years within the renal registry). A majority (77.8%) of vaccine received messenger RNA-based regimens. Their median (IQR) Naranjo score was 8 (6-9) points, while 14 of them (51.9%) had a definite probability (Naranjo score ≥ 9). The etiologies of AKD included glomerular disease (n = 16) consisting of seven IgA nephropathy, four anti-neutrophil cytoplasmic antibodies-associated glomerulonephritis (AAN), three membranous glomerulonephritis, two minimal change diseases, and chronic kidney disease (CKD) with acute deterioration (n = 11). Extra-renal manifestations were found in four patients. Over a median (IQR) follow-up period of 42 (36.5-49.5) weeks, six patients progressed to end-stage kidney disease (ESKD). Conclusion Besides glomerulonephritis (GN), the occurrence of AKD following COVID-19 vaccination may be more concerning in high-risk CKD patients receiving multiple doses. Patients with the development of de novo AAN, concurrent extra-renal manifestations, or pre-existing moderate to severe CKD may exhibit poorer kidney prognosis.
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8
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Thammathiwat T, Banjongjit A, Iampenkhae K, Townamchai N, Kanjanabuch T. ANCA Associated Glomerulonephritis Following SARS-CoV-2 Vaccination: A Case Series and Systematic Review. Vaccines (Basel) 2023; 11:vaccines11050983. [PMID: 37243087 DOI: 10.3390/vaccines11050983] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccines against SARS-CoV-2 (COVID-19) proved beneficial for COVID-19 disease attenuation and preventing virus spreading. Cumulative reports of the rarity of antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitis (AAV) raise concerns about its relationship with COVID-19 vaccination. Several case reports described ANCA-associated pauci-immune glomerulonephritis (ANCA-GN) following COVID-19 vaccination with some uniqueness. We systematically reviewed COVID-19 vaccine-induced ANCA-GN from PubMed, SCOPUS, and Cochrane library databases until 1 January 2023 according to PRISMA guidelines and presented our three cases. Twenty-six cases from 25 articles, including our 3 cases, were analyzed. Most cases were diagnosed following the second dose of the COVID-19 vaccine (59%) with a median (IQR) interval onset of 14 (16) days. The highest prevalence was related to the mRNA-type vaccine. Anti-myeloperoxidase (MPO) ANCA was far more common than the other ANCAs, with various positive autoantibodies. Fourteen cases (out of 29 cases, 48%) had extra-kidney AAV manifestation. Although severe kidney injury was observed in 10/29 (34%), remission was achieved in 89% (25/28) with no death. The mechanisms of the vaccine-inducing ANCA-GN were postulated here. Since ANCA-GN after the COVID-19 vaccine was rare, the benefit of the COVID-19 vaccine could outweigh the risk of ANCA-GN side effects in the pandemic era.
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Affiliation(s)
- Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Athiphat Banjongjit
- Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok 10400, Thailand
| | - Kroonpong Iampenkhae
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Natavudh Townamchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Renal Immunology and Renal Transplant Research Unit, Chulalongkorn University, Bangkok 10330, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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9
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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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10
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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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11
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Zhao Y, Zhao Y, Zhou Y, Zhang Z, Zhang Y, Li M, Su X, Jin L. Inactivated COVID-19 vaccination and maternal renal function during early pregnancy: A retrospective cohort study of 6397 Chinese pregnant women. J Infect 2023; 86:154-225. [PMID: 36427631 PMCID: PMC9683864 DOI: 10.1016/j.jinf.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Liping Jin
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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12
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Kawamura T, Nakazawa D, Nishio S, Isozaki T, Komatsumoto M, Atsumi T. Development of ANCA-associated vasculitis followed by SARS-CoV-2 vaccination in a patient with HLA-DRB1*09: 01 allele. Mod Rheumatol Case Rep 2023:6970048. [PMID: 36610742 DOI: 10.1093/mrcr/rxac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/24/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with severe pneumonia and fatal systemic complications. Currently, SARS-CoV-2 vaccines are effective in reducing the risk of new onset and getting worse of the disease. However, autoimmune diseases such as antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) have been reported to develop after COVID-19 vaccine administration. Case presentation: A 71-year-old woman presented with fever, malaise, urinary abnormalities and renal dysfunction after receiving the COVID-19 vaccine (Pfizer-BioNTech). We clinically diagnosed AAV with her manifestations and serological test (MPO-ANCA positive). Her clinical findings were improved after immunosuppressive therapy. We examined her genetic susceptibility to AAV and we found that her allele was HLA-DRB1*09:01, which is a risk allele of MPO-AAV. Mechanistically, SARS-CoV-2 vaccines would activate immunity, including neutrophils, and trigger AAV onset in this patient with a genetic risk to develop AAV. The pathophysiology of this case would share with that of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in the absence of external adjuvants.
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Affiliation(s)
- Takuro Kawamura
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Saori Nishio
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Taiki Isozaki
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Maki Komatsumoto
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
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13
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Han H, Zhao D, Fang X, Yang W, Wang M, Liu Q, Wang L, Ji Z, Zhang J, Hou Z, Hua L, Wang Y, Wu L. A retrospective cohort study: vaccination status and safety analysis of SARS-CoV-2 vaccine in patients with Wilson's disease. Expert Rev Vaccines 2023; 22:1185-1195. [PMID: 38010939 DOI: 10.1080/14760584.2023.2288630] [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: 06/25/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Wilson's disease (WD) is a rare hepatic and neurological disorder, which can dramatically worsen by traumatic injuries, surgeries, and infections. No studies have reported safety data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in WD patients. We aimed to investigate the SARS-CoV-2 vaccination status and post-vaccination adverse events in WD patients. METHODS This is a multicenter, retrospective, observational study. We investigated the vaccination rates, the type of vaccine, subjective reasons for non-vaccination, and the adverse events following vaccination. Logistic regression analysis was used to assess the correlation between vaccination status and increased Unified Wilson's Disease Rating Scale (UWDRS) scores. RESULTS A total of 554 WD patients with a mean (SD) age of 25.3 (10.85) years were included in this study, of whom 336 (60.6%) were males and 218 (39.4%) were females. 368 (66.4%) patients received at least one dose of the SARS-CoV-2 vaccine.186 (33.6%) patients were unvaccinated. Logistic regression analysis showed that vaccination against SARS-CoV-2 was not significantly associated with increased UWDRS scores. The safety analysis demonstrated that 21.2% had post-vaccination adverse events. CONCLUSIONS In this study, vaccination against SARS-CoV-2 was safe in WD patients, providing evidence for the safety of vaccination in WD patients.
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Affiliation(s)
- Hui Han
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Dan Zhao
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Xinru Fang
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Wenming Yang
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Mengli Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Qianzhuo Liu
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Luyao Wang
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Zhihui Ji
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Juan Zhang
- Neurology Department, The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Zhifeng Hou
- Neurology Department, Anhui integrated traditional Chinese and Western Medicine Hospital, Hefei, Anhui, People's Republic of China
| | - Lei Hua
- Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Yu Wang
- Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Limin Wu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
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14
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Immunogenicity and safety of SARS-CoV-2 mRNA vaccine in patients with nephrotic syndrome receiving immunosuppressive agents. Pediatr Nephrol 2023; 38:1099-1106. [PMID: 35913562 PMCID: PMC9340689 DOI: 10.1007/s00467-022-05633-y] [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: 04/09/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND As there are no large-scale reports of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mRNA vaccination in patients with nephrotic syndrome using immunosuppressive agents, we conducted the prospective study. METHODS SARS-CoV-2 mRNA vaccines were administered to patients with nephrotic syndrome receiving immunosuppressive agents. The titers of SARS-CoV-2 spike protein receptor-binding domain antibodies were measured before and after vaccination. We evaluated factors associated with antibody titers after vaccination and analyzed adverse events. RESULTS We enrolled 40 patients and evaluated vaccine immunogenicity in 35 of them. Seroconversion (> 0.8 U/mL) was achieved in all patients, and the median antibody titer was 598 U/mL (interquartile range, 89-1380 U/mL). Patients using mycophenolate mofetil (MMF) showed lower antibody titers than those who were not (median: 272 U/mL vs. 2660 U/mL, p = 0.0002), and serum immunoglobulin G (IgG) levels showed a weak linear relationship with antibody titers (R2 = 0.16). No breakthrough infections were noted. Three patients (7.5%) suffered from a relapse of nephrotic syndrome (2 and 3 days, respectively, after the first dose and 8 days after the second dose), two of whom had a history of relapse within 6 months before the vaccination. CONCLUSIONS The SARS-CoV-2 mRNA vaccine was immunogenic in patients with nephrotic syndrome using immunosuppressive agents, although the use of MMF and low levels of serum IgG were associated with lower antibody titers after vaccination. Patients with high disease activity may experience a relapse of nephrotic syndrome after vaccination. A higher resolution version of the Graphical abstract is available as Supplementary information.
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15
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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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16
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Pacheco ICR, Costa DMDN, Sousa DS, Salgado Filho N, Silva GEB, Neves PDMDM. Kidney injury associated with COVID-19 infection and vaccine: A narrative review. Front Med (Lausanne) 2022; 9:956158. [PMID: 36544502 PMCID: PMC9760714 DOI: 10.3389/fmed.2022.956158] [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: 05/29/2022] [Accepted: 11/11/2022] [Indexed: 12/08/2022] Open
Abstract
The respiratory tract is the main infection site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in many admissions to intensive care centers in several countries. However, in addition to lung involvement, kidney injury caused by the novel coronavirus has proven to be a significant factor related to high morbidity and mortality, alarming experts worldwide. The number of deaths has drastically reduced with the advent of large-scale immunization, highlighting the importance of vaccination as the best way to combat the pandemic. Despite the undeniable efficacy of the vaccine, the renal side effects associated with its use deserve to be highlighted, especially the emergence or reactivation of glomerulopathies mentioned in some case reports. This study aimed to identify the main renal morphological findings correlated with COVID-19 infection and its vaccination, seeking to understand the pathophysiological mechanisms, main clinical features, and outcomes.
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Affiliation(s)
| | | | - Deborah Serra Sousa
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil
| | - Natalino Salgado Filho
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil
| | - Gyl Eanes Barros Silva
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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17
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Diebold M, Locher E, Boide P, Enzler-Tschudy A, Faivre A, Fischer I, Helmchen B, Hopfer H, Kim MJ, Moll S, Nanchen G, Rotman S, Saganas C, Seeger H, Kistler AD. Incidence of new onset glomerulonephritis after SARS-CoV-2 mRNA vaccination is not increased. Kidney Int 2022; 102:1409-1419. [PMID: 36096267 PMCID: PMC9462927 DOI: 10.1016/j.kint.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 01/12/2023]
Abstract
Numerous cases of glomerulonephritis manifesting shortly after SARS-CoV-2 vaccination have been reported, but causality remains unproven. Here, we studied the association between mRNA-based SARS-CoV-2 vaccination and new-onset glomerulonephritis using a nationwide retrospective cohort and a case-cohort design. Data from all Swiss pathology institutes processing native kidney biopsies served to calculate incidence of IgA nephropathy, pauci-immune necrotizing glomerulonephritis, minimal change disease, and membranous nephropathy in the adult Swiss population. The observed incidence during the vaccination campaign (January to August 2021) was not different from the expected incidence calculated using a Bayesian model based on the years 2015 to 2019 (incidence rate ratio 0.86, 95% credible interval 0.73-1.02) and did not cross the upper boundary of the 95% credible interval for any month. Among 111 patients 18 years and older with newly diagnosed glomerulonephritis between January and August 2021, 38.7% had received at least one vaccine dose before biopsy, compared to 39.5% of the general Swiss population matched for age and calendar-time. The estimated risk ratio for the development of new-onset biopsy-proven glomerulonephritis was not significant at 0.97 (95% confidence interval 0.66-1.42) in vaccinated vs. unvaccinated individuals. Patients with glomerulonephritis manifesting within four weeks after vaccination did not differ clinically from those manifesting temporally unrelated to vaccination. Thus, vaccination against SARS-CoV-2 was not associated with new-onset glomerulonephritis in these two complementary studies with most temporal associations between SARS-CoV-2 vaccination and glomerulonephritis likely coincidental.
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Affiliation(s)
- Matthias Diebold
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Eleonore Locher
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Philipp Boide
- Clinic for Nephrology and Transplantation, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Anna Faivre
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland; Service of Nephrology, Division of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ingeborg Fischer
- Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Birgit Helmchen
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Helmut Hopfer
- Department of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Min Jeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Solange Moll
- Clinical Pathology Division, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Giliane Nanchen
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas D Kistler
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Medicine, Cantonal Hospital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
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18
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Ahmed M, Mohamed S, Alhussein H, Eltazi I, Sibira RM, Abdulhadi A. COVID-19 Vaccine as a Potential Triggering Factor for Anti-Glomerular Basement Membrane (GBM) Disease: A Case Report and Literature Review. Cureus 2022; 14:e29075. [PMID: 36258941 PMCID: PMC9559358 DOI: 10.7759/cureus.29075] [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] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Coronavirus 2019 (COVID-19) is considered one of the most significant medical pandemics of this century, with high morbidity and mortality associated with the pandemic. The virus was recognized initially as a cause of pneumonia, but subsequent studies showed significant association with gastrointestinal, neurological, and autoimmune diseases. By 2020, several vaccines became available for use, significantly reducing the infection rate. A good safety profile supported most of the studies related to vaccines. However, this area is still under study, and some reports linked the COVID-19 vaccine to the development of thrombocytopenia, thrombosis, Guillain-Barre syndrome, autoimmune diseases, and myocarditis. These side effects need to be reported to VAERS (Vaccine Adverse Event Reporting System). The exact etiology of anti-glomerular basement (Anti-GBM) disease remains unknown, but the disease is thought to be triggered by environmental factors in genetically predisposed individuals. It is considered one of the serious diseases that could lead to permanent kidney impairment if not treated early and adequately. That's why a great effort is being made by health care practitioners to figure out and avoid the risk and triggering factors. Few previously published papers linked the COVID-19 vaccine and the development of anti-GBM disease, which raised concerns about digging more into this area. Herein, we are reporting a case of a patient who developed rapidly progressive glomerulonephritis (RPGN) due to anti-glomerular basement membrane (GBM) antibody disease two days after receiving the second dose of the COVID-19 vaccine.
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19
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Zhao WM, Wang ZJ, Shi R, Zhu YY, Zhang S, Wang RF, Wang DG. Environmental factors influencing the risk of ANCA-associated vasculitis. Front Immunol 2022; 13:991256. [PMID: 36119110 PMCID: PMC9479327 DOI: 10.3389/fimmu.2022.991256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of diseases characterized by inflammation and destruction of small and medium-sized blood vessels. Clinical disease phenotypes include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The incidence of AAV has been on the rise in recent years with advances in ANCA testing. The etiology and pathogenesis of AAV are multifactorial and influenced by both genetic and environmental factors, as well as innate and adaptive immune system responses. Multiple case reports have shown that sustained exposure to silica in an occupational environment resulted in a significantly increased risk of ANCA positivity. A meta-analysis involving six case-control studies showed that silica exposure was positively associated with AAV incidence. Additionally, exposure to air pollutants, such as carbon monoxide (CO), is a risk factor for AAV. AAV has seasonal trends. Studies have shown that various environmental factors stimulate the body to activate neutrophils and expose their own antigens, resulting in the release of proteases and neutrophil extracellular traps, which damage vascular endothelial cells. Additionally, the activation of complement replacement pathways may exacerbate vascular inflammation. However, the role of environmental factors in the etiology of AAV remains unclear and has received little attention. In this review, we summarized the recent literature on the study of environmental factors, such as seasons, air pollution, latitude, silica, and microbial infection, in AAV with the aim of exploring the relationship between environmental factors and AAV and possible mechanisms of action to provide a scientific basis for the prevention and treatment of AAV.
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20
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Autoimmune inflammatory rheumatic diseases post-COVID-19 vaccination. Int Immunopharmacol 2022; 110:109061. [PMID: 35978510 PMCID: PMC9283674 DOI: 10.1016/j.intimp.2022.109061] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022]
Abstract
Vaccination against COVID-19 is one of the critical tools to provide herd immunity, reduce mortality, and control the pandemic worldwide. Despite the safety of vaccination against SARS-CoV-2 in the healthy population, a minority of people may develop rare post-vaccine adverse reactions such as autoimmune syndromes. The current study aimed to identify and present a series of patients with de-novo autoimmune rheumatic diseases (ARDs) associated with COVID-19 vaccines. Inclusion criteria were the onset of ARDs symptoms at ∼3-4 weeks post-vaccination, age ≥ 16, no previous history of ARDs, meeting the classification criteria for one of the ARDs, and staying in the follow-up. The most commonly used vaccines in patients were Sinopharm [7 cases (50%)] and AstraZeneca [6 cases (42.9%)]. ARDs were significantly more common in subjects who received the AstraZeneca vaccine than in those who received other vaccines. Based on the results, patients were diagnosed with rheumatoid arthritis or one of its subtypes (5 cases), vasculitis (4 cases), systemic lupus erythematosus (3 cases), and peripheral seronegative spondyloarthritis (2 cases). Except for one patient with self-limitation of ARD, others were treated with disease-modifying antirheumatic drugs, and one case developed irreversible neurological complications. Indeed, our data can warn physicians about the possibility of ARDs post-vaccination, lead to faster diagnosis, prevent loss of window of opportunity for treatment, and prevent irreversible organ damage. Based on the published literature, autoimmune phenomena post-COVID-19 vaccination may be related to the overstimulation of mediators and cytokines due to complicated antigen-specific/non-specific immunological responses and mechanisms.
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21
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Cancarevic I, Nassar M, Medina L, Sanchez A, Parikh A, Hosna A, Devanabanda B, Vest M, Ayotunde F, Ghallab M, Omran I. Nephrotic Syndrome in Adult Patients With COVID-19 Infection or Post COVID-19 Vaccine: A Systematic Review. Cureus 2022; 14:e29613. [PMID: 36312654 PMCID: PMC9595350 DOI: 10.7759/cureus.29613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Nephrotic syndrome is a condition characterized by damage to podocytes that results in significant proteinuria, edema, hyperlipidemia, and hypercoagulability. Infections and malignancies are frequently associated with nephrotic syndrome. The COVID-19 virus has been associated with several atypical presentations of upper respiratory infections and acute kidney injury. Considering that COVID-19 causes systemic inflammatory changes, it seems plausible that it may also lead to nephrotic syndrome. This study aimed to investigate if an association between COVID-19 and the different types of nephrotic syndromes exists. Data were extracted into a spreadsheet. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY, USA). We performed a systematic search of PubMed/Medline and Embase databases using both medical subject headings (MeSH) and regular keywords associated with COVID-19 and nephrotic syndrome, including different types of nephrotic syndromes. The search was performed on 17th December 2021. We included case reports and case series about adult patients who developed findings suggestive of nephrotic syndrome shortly after infection or vaccination. We excluded cases involving children, pregnant women, articles written in languages other than English, and those that were not retrievable. The relevance and quality of identified articles were assessed. We included 32 articles in the study, primarily case reports and case series. In our study, COVID-19 and the COVID-19 vaccine have been associated with the development of nephrotic syndrome, primarily a collapsing form of focal segmental glomerulosclerosis, although other forms have been observed as well. There was little consistency in patient histories, clinical presentations, clinical courses, or treatment regimens, although it appeared that most cases eventually resolved. More cases need to be reported and analyzed before more definitive conclusions can be reached. In conclusion, nephrotic syndrome is a possible complication of both COVID-19 infection and the COVD-19 vaccine and should be considered in patients exhibiting sudden onset edemas or deterioration in kidney function. While the majority of cases respond to standard treatment, clearer guidelines will need to be developed once more data is available.
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Affiliation(s)
- Ivan Cancarevic
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Luis Medina
- Internal Medicine, Queens Hospital Center, New York, USA
| | - Angelica Sanchez
- Internal Medicine, Universidad Autónoma de Santo Domingo, San Francisco de Macorís, DOM
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Asma Hosna
- Internal Medicine, Mount Sinai Hospital, New York , USA
| | - Bhavana Devanabanda
- Integrative Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Mallorie Vest
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Fatima Ayotunde
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
| | - Ismail Omran
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York, USA
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22
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Hummel A, Oniszczuk J, Kervella D, Charbit M, Guerrot D, Testa A, Philipponnet C, Chauvet C, Guincestre T, Brochard K, Benezech A, Figueres L, Belenfant X, Guarnieri A, Demoulin N, Benetti E, Miglinas M, Dessaix K, Morelle J, Angeletti A, Sellier-Leclerc AL, Ranchin B, Goussard G, Hudier L, Bacchetta J, Servais A, Audard V. Idiopathic nephrotic syndrome relapse following SARS-CoV-2 vaccination: a series of 25 cases. Clin Kidney J 2022; 15:1574-1582. [PMID: 35979142 PMCID: PMC9129143 DOI: 10.1093/ckj/sfac134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several cases of idiopathic nephrotic syndrome (INS) relapse following the administration of coronavirus disease 2019 (COVID-19) vaccines have recently been reported, raising questions about the potential relationship between the immune response to COVID-19 vaccination and INS pathogenesis. Methods We performed a retrospective multicentre survey describing the clinical and biological characteristics of patients presenting a relapse of INS after COVID-19 vaccination, with an assessment of outcome under treatment. Results We identified 25 patients (16 men and 9 women) presenting a relapse within 1 month of a COVID-19 vaccine injection. The glomerular disease was of childhood onset in half of the patients and most patients (21/25) had received at least one immunosuppressive drug in addition to steroids for frequently relapsing or steroid-dependent nephrotic syndrome (NS). All patients were in a stable condition at the time of injection and 11 had no specific treatment. In five patients, the last relapse was reported >5 years before vaccine injection. The Pfizer-BioNTech (BNT162b2) vaccine was used in 80% of the patients. In 18 cases, INS relapse occurred after the first injection, a mean of 17.5 days after vaccination. A second injection was nevertheless administered in 14 of these patients. Five relapses occurred after administration of the second dose and two relapses after the administration of the third dose. All but one of the patients received steroids as first-line treatment, with an additional immunosuppressive agent in nine cases. During follow-up, complete remission was achieved in 21 patients, within 1 month in 17 cases. Only one patient had not achieved at least partial remission after 3 months of follow-up. Conclusions This case series suggests that, in rare patients, COVID-19 vaccination may trigger INS relapse that is generally easy to control. These findings should encourage physicians to persuade their patients to complete the COVID-19 vaccination schedule.
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Affiliation(s)
- Aurélie Hummel
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Julie Oniszczuk
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Marina Charbit
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie pédiatrique, Centre de référence MARHEA, centre de référence SNI, Institut Imagine, Université de Paris, Paris, France
| | - Dominique Guerrot
- Department of Nephrology, Hemodialysis and Transplantation, Rouen University Hospital, Rouen, France
- Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Angelo Testa
- E.C.H.O. (Expansion Centre Hémodialyse de l'Ouest) Site Confluent REZE, France
| | - Carole Philipponnet
- Service Nephrologie Dialyse et Transplantation rénale CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Chauvet
- Service de Néphrologie, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Thomas Guincestre
- Service de Néphrologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Karine Brochard
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Ariane Benezech
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Lucile Figueres
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Xavier Belenfant
- Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
| | | | - Nathalie Demoulin
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Marius Miglinas
- Nephrology Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kathleen Dessaix
- Université de Montpellier, Service de Nephrologie, CHU Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Johann Morelle
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, Transplantation, IRCCS Giannini Gaslini Children's Hospital, Via Gerolamo Gaslini 5, Genova, Italy
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Guillaume Goussard
- Service de Néphrologie et Transplantation CHU Poitiers, Poitiers, France
| | - Laurent Hudier
- Service de Néphrologie, Centre Hospitalier Broussais, Saint Malo, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Aude Servais
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Vincent Audard
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
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23
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Nagai K, Iwase M, Ueda A. A case of anti-GBM nephritis following centipede bites and COVID-19 vaccination. CEN Case Rep 2022; 11:166-170. [PMID: 34524643 PMCID: PMC8441946 DOI: 10.1007/s13730-021-00646-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022] Open
Abstract
A case of newly developed anti-glomerular basement membrane (GBM) glomerulonephritis (GN) following centipede bites and COVID-19 vaccination is presented. A 70-year-old woman presented for investigation of mild fever, generalized fatigue, and macroscopic hematuria with no past history of renal disease. One year earlier, she had been bitten by a centipede. Based on the governmental policy, she was given the first COVID-19 vaccination, and the second injection was planned 3 weeks later. Accidentally, she was again bitten by a centipede, and the injured site had swollen severely. Based on a physician's judgment, the interval between vaccinations was extended to 8 weeks. One week after the second vaccination, macroscopic hematuria occurred suddenly, coincident with mild fever. Her serum anti-GBM titer was above the upper limit. There was no pulmonary involvement. Renal pathology showed anti-GBM GN, and she was treated with corticosteroid pulse therapy followed by sequential plasmapheresis. She had advanced renal dysfunction, but was independent of dialysis therapy during the one month of the remission induction therapy phase, and she is being treated with immunosuppressant therapy. Both vaccination and animal bites skew towards Th1 immunity, a key mechanism involved in the development of necrotizing GN evoked by anti-GBM antibody. Though there is no direct evidence for causality linking centipede bites, vaccination, and anti-GBM GN, the risk of anti-GBM GN appears to be increased by excessively induced Th1 immunity.
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Affiliation(s)
- Kei Nagai
- Department of Nephrology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan.
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Mamiko Iwase
- Department of Nephrology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
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24
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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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25
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Purohit S, Piani F, Ordoñez FA, de Lucas-Collantes C, Bauer C, Cara-Fuentes G. Molecular Mechanisms of Proteinuria in Minimal Change Disease. Front Med (Lausanne) 2022; 8:761600. [PMID: 35004732 PMCID: PMC8733331 DOI: 10.3389/fmed.2021.761600] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Minimal change disease (MCD) is the most common type of idiopathic nephrotic syndrome in childhood and represents about 15% cases in adults. It is characterized by massive proteinuria, edema, hypoalbuminemia, and podocyte foot process effacement on electron microscopy. Clinical and experimental studies have shown an association between MCD and immune dysregulation. Given the lack of inflammatory changes or immunocomplex deposits in the kidney tissue, MCD has been traditionally thought to be mediated by an unknown circulating factor(s), probably released by T cells that directly target podocytes leading to podocyte ultrastructural changes and proteinuria. Not surprisingly, research efforts have focused on the role of T cells and podocytes in the disease process. Nevertheless, the pathogenesis of the disease remains a mystery. More recently, B cells have been postulated as an important player in the disease either by activating T cells or by releasing circulating autoantibodies against podocyte targets. There are also few reports of endothelial injury in MCD, but whether glomerular endothelial cells play a role in the disease remains unexplored. Genome-wide association studies are providing insights into the genetic susceptibility to develop the disease and found a link between MCD and certain human haplotype antigen variants. Altogether, these findings emphasize the complex interplay between the immune system, glomerular cells, and the genome, raising the possibility of distinct underlying triggers and/or mechanisms of proteinuria among patients with MCD. The heterogeneity of the disease and the lack of good animal models of MCD remain major obstacles in the understanding of MCD. In this study, we will review the most relevant candidate mediators and mechanisms of proteinuria involved in MCD and the current models of MCD-like injury.
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Affiliation(s)
- Shrey Purohit
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatrics, Section of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
| | - Federica Piani
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Medicine and Surgery Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Flor A Ordoñez
- Division of Pediatric Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Colin Bauer
- Department of Pediatrics, Section of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
| | - Gabriel Cara-Fuentes
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatrics, Section of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
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26
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Affiliation(s)
- Arjun Sekar
- From the Associates in Kidney Care, Des Moines, IA 50314, USA
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27
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Jefferis J, Kassianos AJ, Grivei A, Doucet B, Healy H, Francis L, Mon SY, John GT. SARS-CoV-2 vaccination-associated collapsing glomerulopathy in a kidney transplant recipient. Kidney Int 2022; 101:635-636. [PMID: 34995649 PMCID: PMC8731234 DOI: 10.1016/j.kint.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Julia Jefferis
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Andrew J Kassianos
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Anca Grivei
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Brian Doucet
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Helen Healy
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Leo Francis
- Anatomical Pathology, Pathology Queensland, Health Support Queensland, Brisbane, Australia
| | - Saw Yu Mon
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - George T John
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
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28
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Jha V, Akal R, Mahapatra D, Harikrishnan S, Walia G. Two cases of adult-onset de novo immunoglobulin A vasculitis with nephritis: Post-Covishield (ChAdOx1 nCoV-19; Oxford–Astra Zeneca) vaccination. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Chen CC, Chen HY, Lu CC, Lin SH. Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination. Front Med (Lausanne) 2021; 8:765447. [PMID: 34859017 PMCID: PMC8632021 DOI: 10.3389/fmed.2021.765447] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 01/14/2023] Open
Abstract
The rare and severe adverse effects associated with coronavirus disease of 2019 (COVID-19) vaccination have been under-appreciated, resulting in many instances of inappropriate management. We describe the case of an elderly woman who developed anti-neutrophil cytoplasmic antibody-associated vasculitis with pulmonary renal syndrome approximately 3 weeks after the first dose of COVID-19 mRNA vaccination (Moderna). Her nasopharyngeal polymerase chain reaction test for the COVID-19 RNA virus was negative. Gross hematuria, heavy proteinuria, acute renal failure (serum creatinine up to 6.5 mg/dL), and hemoptysis coupled with a marked increase in serum anti-myeloperoxidase-O antibody were observed. Renal biopsy showed severe vasculitis with pauci-immune crescent glomerulonephritis. The pulmonary hemorrhage was resolved and renal function improved following combined plasma exchange and the administration of systemic steroids and anti-CD20 therapy. The early examination of urinalysis and renal function may be crucial for identifying glomerulonephritis and acute renal failure in susceptible patients after COVID-19 vaccination.
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Affiliation(s)
- Chien-Chou Chen
- Department of Internal Medicine, Tri-service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Yang Chen
- Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
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30
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Hanna J, Ingram A, Shao T. Minimal Change Disease After First Dose of Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Review of Minimal Change Disease Related to COVID-19 Vaccine. Can J Kidney Health Dis 2021; 8:20543581211058271. [PMID: 34804557 PMCID: PMC8600548 DOI: 10.1177/20543581211058271] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Rationale: While severe complications are generally uncommon with novel coronavirus
disease 2019 (COVID-19) vaccine, there has been a steady increase in the
number of patients presenting with nephrotic syndrome and acute kidney
injury after the administration of COVID-19 vaccine. Physicians should be
made aware of minimal change disease as a potential complication associated
with COVID-19 vaccine. Presenting concerns: A 60-year-old male without significant past medical history presented with
new onset of nephrotic syndrome approximately 10 days after his first dose
of Pfizer-BioNTech COVID-19 vaccine. Laboratory findings showed
hypoalbuminemia (20 g/L), elevated urine albumin/creatinine ratio (668
mg/mmol), and elevated creatinine of 116 µmol/L from a baseline of 79
µmol/L. Diagnosis: A diagnostic kidney biopsy was performed 6 weeks after the onset of the edema
and approximately 8 weeks after his first dose of Pfizer-BioNTech COVID-19
vaccine. The kidney biopsy findings were consistent with minimal change
disease with focal acute tubular injury. Interventions: The patient was treated conservatively with ramipril 10 mg and furosemide 80
mg daily 5 weeks after the onset of swelling. Prednisone 1 mg/kg was
initiated immediately when the kidney biopsy result became available
(approximately 6 weeks after the onset of edema). Outcomes: The patient remitted with rapid weight loss starting 2 weeks post prednisone
initiation. Novel findings: De novo minimal change disease with acute tubular injury is a kidney
manifestation following the administration of Pfizer-BioNTech COVID-19
vaccine. Minimal change disease is potentially a rare complication of
Pfizer-BioNTech COVID-19 vaccine.
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Affiliation(s)
- Jessica Hanna
- Department of Pathology and Molecular Medicine, McMaster University, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Alistair Ingram
- Department of Medicine, Division of Nephrology, McMaster University, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Tiffany Shao
- Department of Pathology and Molecular Medicine, McMaster University, St. Joseph's Healthcare Hamilton, ON, Canada
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31
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Dormann* H, Knüppel-Ruppert* A, Amann K, Erley C. Nephrotic Syndrome After Vaccination Against COVID-19: Three New Cases From Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:662-663. [PMID: 34919048 PMCID: PMC8762589 DOI: 10.3238/arztebl.m2021.0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Harald Dormann*
- Central Emergency Department, Hospital Fürth, Fürth, Germany
- *The authors share co-first authorship
| | - Anja Knüppel-Ruppert*
- Central Emergency Department, Hospital Fürth, Study Coordination Office, Fürth, Germany
- *The authors share co-first authorship
| | - Kerstin Amann
- Department of Nephropathology, FAU Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christiane Erley
- Department of Medicine II with Dialysis, St. Joseph Hospital, Berlin, Germany
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Obata S, Hidaka S, Yamano M, Yanai M, Ishioka K, Kobayashi S. MPO-ANCA-associated vasculitis after the Pfizer/BioNTech SARS-CoV-2 vaccination. Clin Kidney J 2021; 15:357-359. [PMID: 35140936 PMCID: PMC8500057 DOI: 10.1093/ckj/sfab181] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 01/06/2023] Open
Abstract
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has demonstrated high efficacy at preventing coronavirus disease 2019 (COVID-19) and a favorable safety profile, however it has also been reported that COVID-19 vaccines may put increase of immune-mediated disease. We herein report a case of MPO-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis following the mRNA vaccine BNT162b2 (Pfizer/BioNTech) for COVID-19. Although the causal relationship between vaccine and ANCA-associated vasculitis is uncertain, environmental and genetic factors may have set the stage for the development of vasculitis, and the vaccine may have triggered a domino effect.
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Affiliation(s)
- Shota Obata
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Mizuki Yamano
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Mitsuru Yanai
- Department of Pathology, Sapporo Tokushukai Hospital, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
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