ABSTRACT
Introduction: COVID-19 is a problem for the humanity. Since now, 526.534.751 of confirmed cases. The world campain vaccination started in the end of 2020. Until now, we had almost 12 bilions people vaccinated. We never had in the world a massive vaccination campain like that. Considering that medications and vaccines can present adverse events, some cases of glomerulopathies were described. Case Description: We describe 50 yea-old white male patient who was obese and presented hypertension well controlled with Six months before admission, routine blood and urine tests were normal. He received two doses of Coronavac (Sinovac, China) inactivated virus vaccine for Covid-19 (28 day interval between dosses). On December 2021, he received a third dose (booster) Covid-19 vaccine from Pfizer-BioNtech (RNA). One day later, he began to experience high fever lasting one day, severe and progressively chest pain. The patient was hospitalized with pericarditis and AKI KDIGO 1. Corticosteroids and support measures were taken leading to an improvement in the cardiac condition. Two weeks later, renal function progressively worsened, and hematuria and proteinuria ensured. Investigation was negative for autoimmune diseases, serum levels C3 and C4 were normal, and viral serologies were negative. The creatinine level rised to 5 mg/dL (440 mmol/L). A pulse of 1 g methylprednisone was initiated for 3 days. Renal biopsy showed necrotizing glomerulonephritis, with fibrocellular crescents and immune paucity. Two doses of Rituximab 1g was added and prednisone 1 mg/kg and azathioprine were used as maintenance regimen. After 4 months of treatment, the patient presented partial recovery of renal function with a creatinine of 1.7 mg/dL (150 mmol/L). Discussion(s): Glomerulopathies related to Covid infection and vaccines are scarce. Rocatello et al reported 17 cases of post-vaccination glomerulopathies, most of which were of minimal change disease with no case of necrotizing pauci immune-negative being related. Few cases were reported with positive ANCA-related necrotizing GN, and in the present case the patient had all negative antibodies. A causal relationship cannot be stated, but with mass vaccination, cases of rare adverse effects must be monitored and reported to better clarify their mechanisms and evolution.