Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases. Issue 11 (25th November 2021) - Caza, Tiffany N.
Visual Abstract: Abstract : Key Points: This study identified 29 patients with glomerular disease development in close temporal association with SARS-CoV-2 immunization. Kidney biopsies showed IgA nephropathy, minimal change disease, membranous nephropathy, crescentic GN, and collapsing GN. Patients with de novo collapsing GN in temporal association with SARS-CoV-2 vaccination had two APOL1 genomic risk alleles (high-risk genotype). Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient reports and small series is also provided to include all reported cases to date ( n =52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown; however, there was no overall increase in incidence of glomerular disease when compared with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.