Glomerular disease in temporal association to SARS-CoV-2 RNA vaccination: A series of 16 cases

ABSTRACT

Background: Vaccination is considered safe in patients with chronic kidney disease. However, given the ability to activate the immune system, immunizations carry a risk of inducing inflammatory disease flares. The mass vaccination for SARS-CoV-2 provides a unique opportunity to investigate potential vaccine-associated glomerular diseases. Methods: Kidney biopsies from patients who presented with acute kidney injury (AKI) and/or nephritic/nephrotic syndrome within three weeks of SARS-CoV-2 vaccination were included in the study (n=16). Kidney biopsies were reviewed at a single center and clinical information was provided from nephrologists for clinicopathologic correlation. Results: Sixteen patients with a new onset of kidney disease or flare within 3 weeks of SARS-CoV-2 vaccination were identified and all had glomerular disease on biopsy. Eleven patients had two vaccine doses prior to symptom onset. The patient cohort included 6 males and 10 females, with a mean age of 58 years. Biopsy diagnoses included IgA nephropathy (n=7), minimal change disease (n=4), ANCA-associated glomerulonephritis (n=3), membranous glomerulopathy (n=1), and diffuse lupus nephritis (n=1). Thirteen patients had co-morbid medical conditions, including hypertension (n=10), diabetes mellitus (n=4), autoimmune disease (n=5), and chronic kidney disease (n=4). The most common clinical presentation was AKI with concurrent nephritic or nephrotic syndrome (n=9), followed by nephritic syndrome with preserved kidney function (n=5), nephrotic syndrome with preserved kidney function (n=1), and isolated hematuria (n=1). Three patients with AKI required dialysis. A majority of patients had an elevated serum creatinine (mean 3.4 mg/dL), 14 had proteinuria (nephrotic range in 4), 11 had hematuria, and 10 had hypoalbuminemia (mean 2.9 g/dL). Six patients had antinuclear antibodies and 4 had a positive ANCA serology at the time of biopsy. Clinical follow-up is ongoing. Conclusions: IgA nephropathy, minimal change disease, ANCA-associated glomerulonephritis, membranous glomerulopathy, and lupus nephritis were identified with temporal association with SARS-CoV-2 vaccination. In the setting of mass vaccination, causality is unclear, but a new onset of glomerular disease should be monitored as a potential adverse event.