New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

Abstract

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review. Results: Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy. Conclusion: This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.

Eosinophilic Granulomatosis with Polyangiitis Relapse after COVID-19 Vaccination: A Case Report

“…She also had mild COVID-19 three months before the vaccine and we think this may have had an impact on the clinical course. In the recent literature there are reports of new onset of ANCA vasculitis but with a predominantly renal impairment in term of crescentic glomerulonephritis [10,11]. As far as we know, this is the first case report in literature of EGPA flared after the first dose of the mRNA BNT162b2 vaccine.…”

“…A recent case report described the onset of ANCA-associated glomerulonephritis after the Moderna vaccine [9]. In the literature there are reports of IgA nephropathy after vaccination for SARS-CoV-2, especially after the second dose, that may be linked to the strong capability of the mRNA vaccines to induce both cellular and humoral immune responses [10].…”

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review

“…Our systematic review has been able to pool the currently reported cases of new-onset and relapsed intrinsic kidney pathology in children and adolescents following COVID-19 infection, and summarises the purported mechanisms behind the links between COVID-19 and the onset of intrinsic kidney disease. Although the adverse renal complications of COVID-19 vaccination are recognized in adults, these are very rare [ 59 ]. The progressive introduction of COVID-19 vaccination programs for children and adolescents may ultimately lead to decline of COVID-19-associated severe illness and kidney pathological manifestations within the pediatric population.…”

Minimal change disease and acute interstitial nephritis following SARS-CoV-2 BNT162b2 vaccination

“…Pfizer-BioNTech SARS-CoV-2 BNT162b2 mRNA vaccine has met efficacy and safety standards, and received emergency authorization for children aged 5 years and above. The vaccine has been described as a potential trigger of glomerular diseases in adults [2]. Here, we describe new-onset minimal change disease (MCD) and acute interstitial nephritis (AIN) related to the SARS-CoV-2 BNT162b2 vaccine.…”

“…The only other published pediatric case described a patient with steroid-sensitive nephrotic syndrome and stable kidney function following mRNA COVID-19 vaccination [3]. As MCD related to the SARS-CoV-2 BNT162b2 vaccine often develops within the first week of vaccination, the strong temporal association suggests that the T-cell mediated immune response to the SARS-CoV-2 BNT162b2 vaccine could be a potential trigger for podocytopathy [2,3]. Our case provides additional support for a possible association between the SARS-CoV-2 BNT162b2 vaccine and pediatric kidney disease.…”