Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Abstract

The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

“…Advanced CKD appears to be associated with an increased risk of severe infection, although causality remains unclear (57,58). Moreover, results from the International Registry of COVID infection in glomerulonephritis confirmed higher mortality (15% vs. 5%) and an increased risk of acute kidney injury (AKI) (39% vs. 14%) in this population compared with controls (59). Interestingly, however, immunosuppressive treatment before the onset of SARS-CoV2 infection was not associated with increased mortality or AKI in GD patients, not supporting the discontinuation of these medications.…”

“…Given the outcomes observed by Waldman et al (59), we should define the timing and priority of COVID-19 vaccination in patients with IMIDs associated with CKD, especially when pharmacologically immunosuppressed, considering how effective and safe the vaccine will be. Based on the available evidence, we believe that GD patients, more prone to develop severe clinical manifestations of SARS-CoV-19 infection, should undergo the COVID-19 vaccination because of a favorable risk/ benefit ratio.…”

Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD

“…A paucity of data exists on the disease course of COVID-19 in patients on immunosuppression. An analysis of the International Registry of COVID infection in glomerulonephritis indicated that mortality rates are comparable to those observed in dialysis and transplant patients [ 15 ]. There are specific considerations in these patient groups, which have been recently outlined by the Immunonephrology Working Group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) [ 16 ].…”

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

“…The effects SARS-CoV-2 infection has on individuals with immune-mediated glomerulonephritis (GN) were studied by Waldman et al in the IRoc-GN international registry [90]. In this study, 40 patients with biopsy-proven GN and COVID-19 were compared to 80 controls without GN who were hospitalized with COVID-19.…”