Post covishield (ChAdOx1 nCoV-19) vaccination: New onset focal segmental glomerulosclerosis resistant to steroid and calcineurin inhibitor

Abstract

With the ongoing mass COVID vaccination program, various case reports link the COVID-19 vaccines with heightened off-target immune responses leading to de novo development or relapse of various glomerular diseases. Very few glomerular diseases (totally nine published cases to date) have been reported post ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccination compared to more potent m RNA vaccine. In this case report, we present a case of de novo focal segmental glomerulosclerosis (FSGS) post ChAdOx1 nCoV-19 vaccination resistant to steroid and calcineurin inhibitor treatment. To our knowledge, this is the first case of FSGS tip variant reported after the ChAdOx1 nCoV-19 vaccination and the second de novo FSGS case post COVID vaccination (any types of COVID vaccines). We may expect more such types of cases resistant to conventional therapy as the global penetration of vaccination programs will improve.

Insights into new-onset autoimmune diseases after COVID-19 vaccination

“…Focal segmental glomerulosclerosis (FSGS) is a heterogenous syndrome that arises from podocyte injury caused by various factors, and it represents a major cause of kidney disease worldwide [ 77 ]. Recently, five cases of de novo FSGS after COVID-19 vaccination have been reported [ 13 , [78] , [79] , [80] , [81] ] ( Table 5 ), with four of the cases following mRNA vaccine and one following the viral vector vaccine. The majority of patients were women (3/5, 60%) and below 30 years of age (4/5,80%).…”

“…In addition to conservative treatment, all five patients received steroid therapy, and three also received immunosuppressive therapy. Most cases responded well to regular immunosuppression.However, Jha et al reported a case of a 21-year-old male patient who developed de novo FSGS after ChAdOx1 nCoV-19 vaccination and did not respond to steroid + tacrolimus + rituximab therapy, unlike the other four patients [ 78 ]. It is difficult to establish a definite causal relationship between COVID-19 vaccination and FSGS, due to the small number of reported cases.…”