Abstract: PO0105
Glomerular Disease in Temporal Association to SARS-CoV-2 RNA Vaccination: A Series of 16 Cases
Session Information
- COVID-19: Health Systems and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Larsen, Christopher Patrick, Arkana Laboratories, Little Rock, Arkansas, United States
- Walker, Patrick D., Arkana Laboratories, Little Rock, Arkansas, United States
- Seipp, Regan M., DuPage Medical Group, Naperville, Illinois, United States
- Amin, Hassan, The Kidney Group of Memphis, Memphis, Tennessee, United States
- Vancea, Irina, South Colorado Nephrology Associates, Pueblo, Colorado, United States
- Ziadie, Mandolin S., Memorial Regional Hospital, Miramar, Florida, United States
- Messias, Nidia Cordeiro, Arkana Laboratories, Little Rock, Arkansas, United States
- Cassol, Clarissa Araujo, Arkana Laboratories, Little Rock, Arkansas, United States
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.
Conclusion
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.