ABSTRACT
BACKGROUND AND AIMS: After the start of the vaccination campaign against the SARS-COV-2 pandemic, it is possible that the number of cases of De novo and relapsing glomerulopathies will increase. So far, most of the publications related to post-vaccination minimal change disease (also associated with other vaccines against influenza virus, hepatitis B, pneumococcus, etc.) and IgA nephropathy. However, post-vaccination cases of membranous nephropathy, ANCA vasculitis or anti-glomerular basement membrane glomerulonephritis are anecdotal. Likewise, there are no cases of segmental and focal glomerulonephritis published in the literature. We present the cases that have appeared in our centre in order to support the theory of a more than probably causal relationship. We highlight two cases of focal and segmental glomerulonephritis, making this publication the first to report this pathology post-vaccination. METHOD: We present a total of 8 cases reported in our centre since the start of the vaccination campaign. We only considered cases that started with symptoms within 1 month after the first or second dose of the SARS Cov2 vaccine. Histological diagnosis was obtained in four patients with De novo glomerulopathy. In the other four patients with a flare of their baseline disease, renal biopsy was not performed. In these patients, the diagnosis of recurrence was made on the basis of laboratory and clinical data. RESULTS: Five patients of the total that appeared in our centre developed minimal change disease (4 of them were recurrences and 1 De novo), 2 cases of De novo focal and segmental glomerulomephritis and 1 case of De novo IgA nephropathy. Nephrotic range proteinuria and macroscopic haematuria were the most frequent symptoms in our patients and completely reversed after immunosuppressive treatment or, in some cases, with supportive care. All of them received mRNA-based vaccines (six patients with Pfizer and two with Moderna). The mean time to onset of symptoms after vaccination was 13 days. There was no difference in sex and the mean age was 40 years. CONCLUSION: The development of vaccines has been a key factor in the control of the SARS Cov-2 pandemic. The cases reported so far are minimal, compared with the millions of doses administered, so the benefits exceed the risks. However, according to the literature, we recommend closer follow-up in patients with known glomerulopathies and to perform renal biopsy as soon as possible after the onset of symptoms related to post-vaccination renal disease. In our centre, most of the cases appeared after the first dose of vaccination and we induced the administration of the remaining doses because all our patients did well with treatment. However, we suggested that one option might be to delay, but not to stop, the second dose in order not to interfere with the immune response to vaccination in patients who are receiving immunosuppression.