Tiffany N Caza1, Clarissa A Cassol1, Nidia Messias1, Andrew Hannoudi2, Randy S Haun1, Patrick D Walker1, Rebecca M May1, Regan M Seipp3, Elizabeth J Betchick4, Hassan Amin5, Mandolin S Ziadie6, Michael Haderlie7, Joy Eduwu-Okwuwa8, Irina Vancea9, Melvin Seek10, Essam B Elashi11, Ganesh Shenoy12, Sayeed Khalillullah13, Jesse A Flaxenburg14, John Brandt15, Matthew J Diamond16, Adam Frome17, Eugene H Kim18, Gregory Schlessinger19, Erlandas Ulozas20, Janice L Weatherspoon21, Ethan Thomas Hoerschgen22, Steven L Fabian23, Sung Yong Bae24, Bilal Iqbal25, Kanwalijit K Chouhan26, Zeina Karam27, James T Henry28, Christopher P Larsen1. 1. Arkana Laboratories, Little Rock, Arkansas. 2. University of Michigan, Ann Arbor, Michigan. 3. DuPage Medical Group, Naperville, Illinois. 4. Methodist LeBonheur Healthcare-Germantown, Germantown, Tennessee. 5. The Kidney Group of Memphis, Memphis, Tennessee. 6. Memorial Regional Hospital, Miramar, Florida. 7. Iowa Kidney Institute, Bingham Memorial Hospital, Blackfoot, Idaho. 8. Permian Nephrology Associates, Midland, Texas. 9. Southern Colorado Nephrology Associates, Pueblo, Colorado. 10. Ocala Kidney Group, Ocala, Florida. 11. Firelands Physicians Group, Sandusky, Ohio. 12. Lee Kidney Center, Lehigh Acres, Florida. 13. North Florida Nephrology Associates, Tallahassee, Florida. 14. Pikes Peak Nephrology, Colorado Springs, Colorado. 15. Division of Nephrology, University of New Mexico, Albuquerque, New Mexico. 16. Nephrology Associates (Augusta), Augusta, Georgia. 17. Kidney Specialists of North Houston, Shenandoah, Texas. 18. Kidney and Hypertension Specialists PLLC, Manassas, Virginia. 19. Rocky Mountain Kidney Care, Lone Tree, Colorado. 20. Carle Nephrology, Urbana, Illinois. 21. Southern Crescent Nephrology, Stockbridge, Georgia. 22. Springfield Nephrology Associates, Springfield, Missouri. 23. Rocky Mountain Kidney Care, Aurora, Colorado. 24. East Tennessee Nephrology, Knoxville, Tennessee. 25. Kidney Specialists of Southern Nevada, Las Vegas, Nevada. 26. Iowa Kidney Physicians P.C., Des Moines, Iowa. 27. Mercy Clinic Nephrology, Washington, Missouri. 28. Renal Care Associates, Fort Smith, Arkansas.
Abstract
Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown; however, there was no overall increase in incidence of glomerular disease when compared with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.
Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown; however, there was no overall increase in incidence of glomerular disease when compared with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.
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