mRNA COVID-19 Vaccines and Their Risk to Induce a Relapse of Glomerular Diseases

Kronbichler, Andreas; Anders, Hans‐Joachim

doi:10.1681/asn.2022091078

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…In addition, a clinical study recently reported that a second or third vaccination is associated with a two-fold increased risk of a flare-up in patients with IgAN, 18 and there is concern that the repeated stimulation of the immune system by SARS-CoV-2 mRNA vaccination may further increase the frequency of recurrence in patients with glomerular diseases. 19 Therefore, the indication for repeated SARS-CoV-2 mRNA vaccinations in patients with IgAN should be carefully determined individually, considering multiple factors, including the severity of microscopic hematuria and the history of postvaccination gross hematuria.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Gross Hematuria After SARS-CoV-2 mRNA Vaccination in Patients with IgA Nephropathy

et al. 2023

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Background There have been several reports of IgA nephropathy (IgAN) patients with gross hematuria and acute deterioration of urinary findings and kidney function following SARS-CoV-2 mRNA vaccination. Recent case series studies have indicated a possible link between the status of urinary findings at the time of vaccination and the subsequent appearance of gross hematuria. In this study, we aimed to determine whether the status of pre-vaccination urinary findings was associated with post-vaccination gross hematuria in patients already diagnosed with IgAN. Methods Outpatients with IgAN who had been followed up before vaccination were included. We analyzed the association between the remission of pre-vaccination microscopic hematuria (urine sediment <5 red blood cell/high power field) or proteinuria (<0.3 g/gCr) and post-vaccination gross hematuria. Results A total of 417 Japanese patients with IgAN (median age, 51 years; 56% female; estimated glomerular filtration rate (eGFR), 58 mL/min/1.73 m2) were included. The frequency of gross hematuria following vaccination was higher in 20/123 patients (16.3%) with microscopic hematuria than in 5/294 patients (1.7%) without microscopic hematuria prior to vaccination (P <0.001). There was no association between pre-vaccination proteinuria and post-vaccination gross hematuria. After adjusting for potential confounders, such as sex (female), age (<50 years), eGFR (≥60 mL/min/1.73 m2), and histories of tonsillectomy and corticosteroid therapy, pre-vaccination microscopic hematuria was still associated with post-vaccination gross hematuria (OR 8.98, P <0.001). As the severity of pre-vaccination microscopic hematuria increased, the incidence of post-vaccination gross hematuria increased (P <0.001). Conclusions Pre-vaccination microscopic hematuria in patients with IgAN is a major predictor of post-vaccination gross hematuria, regardless of potential confounders including previous treatments for IgAN.

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Section: Discussionmentioning

confidence: 99%

Predictors of Gross Hematuria After SARS-CoV-2 mRNA Vaccination in Patients with IgA Nephropathy

et al. 2023

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“…Some forms of podocytopathy have also been associated with COVID-19 vaccines. Kronbichler et al suggested that there is a temporal and pathogenic association between vaccination and podocytopathies, especially MCD, after the first dose and between other podocytopathies after the second dose [ 22 ]. In a recent systematic review about nephrotic syndrome following COVID-19 immunization, pathogenesis was mainly attributed to the activation of angiotensin-converting enzyme-2 receptors, which leads to podocyte effacement [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review

Araújo,

Campos,

Sodré

et al. 2024

Vaccines

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Large-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.

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“…The difference might be related to the booster effect of the vaccine since most presented cases followed the second and third COVID-19 vaccinations. The booster dose of the COVID-19 vaccine increased the absolute risk of glomerular disease compared to naïve exposure [ 21 ]. The supporting evidence was noted in thioridazine-induced ANCA-AAV (leukocytoclastic vasculitis) that occurred 4 weeks after first exposure compared to a shorter duration of 24 h after rechallenging the dose [ 22 ] similar to minocycline-induced cutaneous lupus 1–2 days after repeated exposure compared to 23 months for the first exposure [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The median (IQR) age was 70 ( 22) years, with female predominance (59%). Most cases presented ANCA-GN after receiving the second vaccination (59%) with a median interval gap of 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days. The mRNA COVID-19 vaccine was the most common (55%), followed by the viral vector vaccine (31%) and inactivated COVID-19 vaccine (14%).…”

Section: Systematic Reviewmentioning

confidence: 99%

ANCA Associated Glomerulonephritis Following SARS-CoV-2 Vaccination: A Case Series and Systematic Review

et al. 2023

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Vaccines against SARS-CoV-2 (COVID-19) proved beneficial for COVID-19 disease attenuation and preventing virus spreading. Cumulative reports of the rarity of antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitis (AAV) raise concerns about its relationship with COVID-19 vaccination. Several case reports described ANCA-associated pauci-immune glomerulonephritis (ANCA-GN) following COVID-19 vaccination with some uniqueness. We systematically reviewed COVID-19 vaccine-induced ANCA-GN from PubMed, SCOPUS, and Cochrane library databases until 1 January 2023 according to PRISMA guidelines and presented our three cases. Twenty-six cases from 25 articles, including our 3 cases, were analyzed. Most cases were diagnosed following the second dose of the COVID-19 vaccine (59%) with a median (IQR) interval onset of 14 (16) days. The highest prevalence was related to the mRNA-type vaccine. Anti-myeloperoxidase (MPO) ANCA was far more common than the other ANCAs, with various positive autoantibodies. Fourteen cases (out of 29 cases, 48%) had extra-kidney AAV manifestation. Although severe kidney injury was observed in 10/29 (34%), remission was achieved in 89% (25/28) with no death. The mechanisms of the vaccine-inducing ANCA-GN were postulated here. Since ANCA-GN after the COVID-19 vaccine was rare, the benefit of the COVID-19 vaccine could outweigh the risk of ANCA-GN side effects in the pandemic era.

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mRNA COVID-19 Vaccines and Their Risk to Induce a Relapse of Glomerular Diseases

Abstract: variants in human genetic disease. Pathway-specific models of podocytopathies and FSGS such as this also highlight the potential in using simpler genetic systems, such as the fly or the zebrafish, as discovery platforms to screen patient-specific therapies for FSGS.

Cited by 7 publications

References 11 publications

Predictors of Gross Hematuria After SARS-CoV-2 mRNA Vaccination in Patients with IgA Nephropathy

Predictors of Gross Hematuria After SARS-CoV-2 mRNA Vaccination in Patients with IgA Nephropathy

Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review

ANCA Associated Glomerulonephritis Following SARS-CoV-2 Vaccination: A Case Series and Systematic Review

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