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Double-Positive Anti-Glomerular Basement Membrane Antibody and Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis Post COVID-19 mRNA vaccine: A Case Series of 4 Patients.
Ting, Julie Anne; Barbir, Elena-Bianca; McRae, Susanna A; Schachter, Michael; De Luca, Linda; Riazy, Maziar; Levin, Adeera.
  • Ting JA; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
  • Barbir EB; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
  • McRae SA; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
  • Schachter M; Department of Pathology, The University of British Columbia, Vancouver, Canada.
  • De Luca L; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
  • Riazy M; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
  • Levin A; Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
Can J Kidney Health Dis ; 10: 20543581231153217, 2023.
Article in English | MEDLINE | ID: covidwho-2284151
ABSTRACT
Rationale Vaccines remain central to the management of COVID-19 pandemic, including the need for repeat doses of vaccines to boost immunity. There has been an accumulating case count of glomerulopathies temporally associated with COVID-19 vaccination. This case series presents 4 patients who developed double-positive anti-glomerular basement membrane antibody (anti-GBM) and myeloperoxidase (MPO) antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis after COVID-19 mRNA vaccination. This report contributes to our collective knowledge about the pathophysiology and clinical outcomes associated with this rare complication. Presenting Concerns of the Patient Four patients developed nephritic syndrome within 1 to 6 weeks after receiving a COVID-19 mRNA vaccine (3 post Pfizer-BioNTech and 1 post Moderna vaccination). Three of the 4 patients also had hemoptysis. Diagnosis Three of the 4 patients had double-positive serology, whereas the fourth patient had renal biopsy findings consistent with double-positive disease, although anti-GBM serology was negative. All patients had renal biopsy findings consistent with double-positive anti-GBM and ANCA-associated glomerulonephritis.

Interventions:

All 4 patients were treated with pulse steroids, cyclophosphamide, and plasmapheresis.

Outcomes:

Of the 4 patients, 1 demonstrated complete remission, 2 remained dialysis-dependent, and the fourth is deceased. Of the 2 patients who received repeat vaccination with COVID-19 mRNA vaccine, 1 patient had second serologic flare of anti-GBM in response to the vaccine. Novel

Findings:

This case series reinforces growing evidence that COVID-19 mRNA vaccine-induced glomerulonephritis is a rare but real phenomenon. Dual ANCA and anti-GBM nephritis can present after the first dose of COVID-19 mRNA vaccine or after several administrations of the vaccine. We are the first to report cases of double-positive MPO ANCA and anti-GBM nephritis after Pfizer-BioNTech vaccination. To our knowledge, we are also the first to report outcomes of repeat COVID-19 vaccination in patients with de novo flare of ANCA and anti-GBM nephritis temporally associated with COVID-19 vaccination.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Topics: Long Covid / Vaccines Language: English Journal: Can J Kidney Health Dis Year: 2023 Document Type: Article Affiliation country: 20543581231153217

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Topics: Long Covid / Vaccines Language: English Journal: Can J Kidney Health Dis Year: 2023 Document Type: Article Affiliation country: 20543581231153217