Membranous Nephropathy in the Era of COVID-19 and Vaccines: Is There a Story to Tell?

Background: Membranous nephropathy is a relatively common glomerular pathology that manifests with either nephrotic or sub-nephrotic range proteinuria. Evidence is emerging of COVID-19 and its vaccines having an influence on various glomerular diseases, including IgA nephropathy and minimal change disease, with limited information on membranous nephropathy. Data from our tertiary centre suggested a rise in cases of membranous nephropathy within a month after vaccination. Method(s): Patients who had renal biopsies in 2021 were identified from pathology results and online clinical records. Information on COVID-19 status, COVID vaccinations and biochemical results were compared. Patients were then split into 2 groups;those presenting within 1 month of vaccination or COVID infection and those who hadn't had vaccinations or a COVID infection within 4 weeks of presentation. Result(s): Complete vaccination and COVID infection history was present in 17 of the 24 patients. Of the 17 patients, 6 were in group 1 and 11 in group 2. 16 out of the 17 patients had nephrotic range proteinuria, 6 also had an AKI at presentation. There was no significant difference in presentation between the groups (see table 1). Conclusion(s): Our data has not conclusively shown a difference between the two groups probably because of the low numbers. But further studies are needed to see if there is a link between either COVID infections or COVID vaccinations and glomerular disease.

Effect of the COVID-19 Pandemic on Clinical Phenotype of Glomerular Disease: Single Centre Experience

Background: Presenting features for glomerular disease can be varied, including but not exclusively, acute kidney injury, nephrotic syndrome or haemo-proteinuria. At our regional tertiary centre we conducted a retrospective study to see whether clinical presentations of glomerular diseases had changed during the COVID-19 pandemic. Method(s): In this study, new and repeat native renal biopsies were included from January 2018 to October 2021. Glomerular pathologies of interest included minimal change disease, membranous nephropathy, IgA nephropathy, lupus nephritis and pauciimmune glomerulonephritis. We looked at three periods of time: prior to the start COVID-19 pandemic in 2018/19;during the COVID-19 pandemic in 2020;and after the introduction of COVID-19 vaccines in 2021. Result(s): 263 biopsies were identified over the 4-year period. IgA nephropathy - n = 13. Lupus nephritis - n = 43. The different classes of lupus nephritis are shown in (see figure 1) Minimal change disease - n = 57. All presented with the nephrotic syndrome. Between 6-25% over the study period presented with AKI (mean 19%) Pauci-immune glomerulonephritis - n = 85. Between 81%-91% over the study period presented with AKI, or AKI on CKD (mean 84%) Membranous glomerulopathy - n = 66. 50%, presented with the nephrotic syndrome. 20% presented with AKI in addition to proteinuria. Conclusion(s): Our analysis has not shown a significant change in clinical presentations of glomerular disease. There has not been an increased propensity in presenting with AKI in minimal change disease or membranous nephropathy. We saw the highest proportion of class IV lupus nephritis in 2021.

Effect of the COVID-19 Pandemic on Incidence of Glomerular Disease: A Single Centre Report

Background: Glomerular disease carries a significant burden of morbidity and mortality. There is emerging evidence of the impact of the COVID-19 pandemic and COVID-19 vaccination on glomerular disease. The aim of the study was to retrospectively analyse our experience of the incidence of glomerular disease between 2018 and 2021. Method(s): Native renal biopsy results were reviewed to compare the incidence of glomerular disease prior to the COVID-19 pandemic (2018/19);prior to development of COVID-19 vaccination (2020);and after the introduction of COVID-19 vaccines (2021). Biopsy data from January 2018 to October 2021 were collated from pathology records for all glomerular disease patients in our unit. We focused on the incidence of IgA nephropathy, lupus nephritis, minimal change disease, membranous nephropathy and pauci-immune glomerulonephritis. Result(s): 263 native biopsies were performed;45 biopsies in 2018, 75 in 2019, 65 in 2020 and 78 in the first ten months of 2021. The proportional incidence of each disease is shown in figure 1. The incidence of membranous nephropathy was noted to be higher in 2021, coinciding with the introduction of the COVID-19 vaccine programme in the UK, from an average of 23% of cases between 2018-2020, to 31% in the first ten months of 2021. The overall incidence of glomerular disease, excluding vasculitis, seemed to have fallen during 2020. Conclusion(s): The emergence of COVID-19 does not appear to have caused a significant increase in the overall incidence of glomerular disease in our population. We noted an increase in the incidence of membranous nephropathy following the introduction of the COVID-19 vaccination programme in 2021. The relatively lower incidence in 2020 could be related to limited access to primary health care practitioners and consequent reduction in referrals to secondary care at the time.