COVID-19 Vaccination and Glomerulonephritis

Nattawat Klomjit; Mariam Priya Alexander; Fernando C Fervenza; Ziad Zoghby; Arvind Garg; Marie C Hogan; Samih H Nasr; Marwan Abu Minshar; Ladan Zand

doi:10.1016/j.ekir.2021.09.008

COVID-19 Vaccination and Glomerulonephritis

Kidney Int Rep. 2021 Dec;6(12):2969-2978. doi: 10.1016/j.ekir.2021.09.008. Epub 2021 Oct 6.

Authors

Nattawat Klomjit^{1

2}, Mariam Priya Alexander³, Fernando C Fervenza¹, Ziad Zoghby¹, Arvind Garg¹, Marie C Hogan¹, Samih H Nasr³, Marwan Abu Minshar⁴, Ladan Zand¹

Affiliations

¹ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
² Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA.
³ Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Division of Nephrology and Hypertension, Essentia Health, Fargo, North Dakota, USA.

Abstract

Introduction: mRNA COVID-19 vaccine is more effective than traditional vaccines owing to superior immune activation. Nevertheless, the impact of mRNA COVID-19 vaccine on triggering de novo/relapsing glomerulonephritis (GN) is limited. We report a case series of patients who developed new or relapsing GN postvaccination.

Methods: We evaluated baseline characteristics, vaccine type, and clinical outcomes of 13 patients from our institution who had a new diagnosis or relapse of their GN post-mRNA COVID-19 vaccination.

Results: Of 13 patients, 8 patients were newly diagnosed with having GN and 5 patients had relapse. Median age was 62 years (range 19-83 years). Autoimmune disease (38%) was the most prevalent underlying disease followed by cancer (23%). Most patients were White males. IgA nephropathy (IgAN) was the most common GN in our series (5 patients, 38%) followed by membranous nephropathy (MN) (3 patients, 23%). There was 1 patient with IgAN who had evidence of IgA deposits before vaccination suggesting the immune activation after vaccination triggered a flare of the disease. Our case series also included the first case report of tip-variant focal segmental glomerulosclerosis (FSGS), NELL-1-associated MN, and atypical anti-glomerular basement membrane (GBM) nephritis. A total of 77% developed acute kidney injury (AKI) with most being Kidney Disease: Improving Global Outcomes stage 1 (67%). Outcomes are favorable with 80% responding to therapy.

Conclusion: New cases and relapse of GN can present shortly after mRNA COVID-19 vaccination. New cases of IgAN may result from unmasking of undiagnosed IgAN owing to robust immune activation rather than development of new deposits.

Keywords: COVID-19; IgA nephropathy; SARS-CoV-2; glomerulonephritis; mRNA vaccine; minimal change disease.