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(searched for: doi:10.1016/j.kint.2021.04.024)
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, Samuel Mon-Wei Yu, Kirk N. Campbell, Miriam Chung, Fadi Salem
Published: 13 July 2021
Abstract:
Here we present the first case of newly diagnosed IgA nephropathy (IgAN) after a SARS-CoV-2 vaccination. A 30-year-old man with no known past medical history presented with gross hematuria and subnephrotic proteinuria 24 hours after the second dose of the mRNA-1273 SARS-CoV-2 vaccine. A kidney biopsy showed IgAN. He was started on an angiotensin receptor blocker resulting in proteinuria reduction. Similar to natural infection of SARS-CoV2, persons who receive two mRNA-based vaccines demonstrate robust antibodies against the receptor-binding domain (RBD) of the S1 protein. Given the uniqueness of glycosylation of RBD and potent stimulation of immune response from mRNA-based vaccine compared to other vaccines, we hypothesize that our patient developed de novo antibodies leading to IgA-containing immune-complex deposits. This case highlights the urgency of understanding the immunological responses to novel mRNA-based SARS-CoV-2 vaccines in more diverse populations. Despite the lack of clear causality, nephrologists should be alerted if any new-onset hematuria or proteinuria is observed.
, Craig Fenwick, Giuseppe Pantaleo
Published: 6 July 2021
The Lancet Rheumatology, Volume 3; https://doi.org/10.1016/s2665-9913(21)00211-3

Abstract:
Uncertainty persists as to the possibility that the COVID-19 vaccines might cause exacerbation of pre-existing autoimmune diseases.1Terracina KA Tan FK Flare of rheumatoid arthritis after COVID-19 vaccination.Lancet Rheumatol. 2021; (published online March 30.)https://doi.org/10.1016/S2665-9913(21)00108-9Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Here we report a case of reactivation of IgA vasculitis occurring after COVID-19 vaccination.
Edward J. Carr, , Matthew Graham-Brown, Graham Abra, Christos Argyropoulos, Lorraine Harper, , Rita S. Suri, Joel Topf, Michelle Willicombe, et al.
Published: 5 July 2021
Kidney International Reports, Volume 6, pp 2292-2304; https://doi.org/10.1016/j.ekir.2021.06.027

Abstract:
Introduction The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. Methods To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. Results We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Conclusions Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
Christian Hanna, Loren P. Herrera Hernandez, Lihong Bu, , Lydia Najera, , Jan Czyzyk,
Published: 4 July 2021
Kidney International, Volume 100, pp 705-706; https://doi.org/10.1016/j.kint.2021.06.032

Abstract:
With great interest, we read the recent reports of IgA nephropathy (IgAN) flare-up presenting as macroscopic hematuria, following the second dose of coronavirus disease 2019 (COVID-19) vaccination in adult patients.1Rahim S.E.G. Lin J.T. Wang J.C. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination.Kidney Int. 2021; 100: 238Google Scholar, 2Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney Int. 2021; 99: 1487Google Scholar, 3Perrin P, Bassand X, Benotmane I, Bouvier N. Gross hematuria following SARS-CoV-2 vaccination in patients with IgA nephropathy [e-pub ahead of print]. Kidney Int. https://dol.org/10.1016/j.kint.2021.05.022.Google Scholar, 4Tan HZ, Tan RY, Choo JCJ, et al. Is COVID-19 vaccination unmasking glomerulonephritis [e-pub ahead of print]? Kidney Int. https://dol.org/10.1016/j.kint.2021.05.009.Google Scholar The US Food and Drug Administration granted an emergency use authorization for the Pfizer-BioNtech COVID-19 vaccination in December 2020 for individuals aged ≥16 years; the emergency use authorization was recently expanded to include children aged 12 to 15 years on May 10, 2021. Herein, we report 2 pediatric patients with IgAN presenting with macroscopic hematuria <24 hours after Pfizer COVID-19 vaccination. Neither patient had COVID-19 infection before vaccination nor any history of reactions to any vaccinations. See Table 1 for clinical information.Table 1Clinical characteristics of 2 pediatric patients with IgAN flare following COVID-19 vaccinationPatient no.Age, yrRaceSexVariablesBefore COVID-19 vaccinationFollowing COVID-19 vaccination113WhiteMaleClinical symptomsMicroscopic hematuria and subnephrotic proteinuria noted on routine urine screening for diabetes, leading to IgAN diagnosisNew-onset gross hematuria × 2 d, vomiting × 1 dSerum creatinine, mg/dl0.54Day 2: 1.31Day 6: 0.66Serum albumin, g/dl3.4Day 2: 3.8Day 6: 3.0Urine protein-to-creatinine ratio, mg/mg1.6Day 2: 1.07Day 6: 0.86Oxford MEST-C scoreM0 E0 S0 T0 C0—TreatmentLisinopril, 10 mg/dayStopped lisinopril on day 5217WhiteMaleClinical symptomsFoamy urine for several monthsNew-onset macroscopic hematuria × 4 d and stage I hypertensionSerum creatinine, mg/dl—Day 6: 1.78Day 9: 1.47Day 22: 1.20 (following corticosteroid treatment)Serum albumin, g/dl—Day 9: 3.8Urine protein-to-creatinine ratio, mg/mg—Day 9: 1.75Oxford MEST-C score—Day 9: M1 E1 S1 T1 C1Treatment—Day 9: 1 g i.v. methylprednisolone daily ×3, followed by oral prednisoneCOVID-19, coronavirus disease 2019; IgAN, IgA nephropathy; MEST-C, M = mesangial hypercellularity, E = endocapillary proliferation, S = segmental glomerulosclerosis, T = tubular atrophy/interstitial fibrosis, C = crescents. Open table in a new tab
Ken Park, Scott Miyake, Cynthia Tai, Mindy Tseng, Nicole K. Andeen,
Published: 18 June 2021
Kidney International Reports, Volume 6, pp 2246-2247; https://doi.org/10.1016/j.ekir.2021.06.007

Abstract:
We have followed with interest reports of female patients (n=4) with indolent IgA nephropathy (IgAN), evidenced by normal kidney function and microscopic hematuria without proteinuria at baseline, presenting after second dose of the Pfizer-BioNtech (n=2) or Moderna (n=2) SARS-CoV-2 mRNA vaccine with self-limited gross hematuria.1Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney International. 2021; 99 (1487)Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 2Gul Rahim S.E. Lin J. Wang J.C. A case of gross hematuria and IgA Nephropathy Flare up following SARS-CoV-2 vaccination.Kidney International. 2021; Google Scholar, 3Tan H.Z. Tan R.Y. Jun Choo J.C. Lim C.C. Tan C.S. Liang Loh A.H. ShanYeu Tien C. Tan P.H. Woo K.T. Is COVID-19 Vaccination unmasking Glomerulonephritis?.Kidney International. 2021; Abstract Full Text Full Text PDF Google Scholar
Satoru Kudose, Paul Friedmann, Oltjon Albajrami,
Published: 16 June 2021
Kidney International, Volume 100, pp 468-469; https://doi.org/10.1016/j.kint.2021.06.011

Abstract:
We read with interest the recent reports of gross hematuria occurring in 4 patients with IgA nephropathy shortly following the second dose of mRNA vaccine for coronavirus disease 2019 (COVID-19).1Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney Int. 2021; 99: 1487Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 2Rahim S.E.G. Lin J.T. Wang J.C. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination.Kidney Int. 2021; 100: 238Abstract Full Text Full Text PDF Google Scholar, 3Tan H.Z. Tan R.Y. Choo J.C.J. et al.Is COVID-19 vaccination unmasking glomerulonephritis [e-pub ahead of print]? Kidney Int.https://doi.org/10.1016/j.kint.2021.05.009Google Scholar These include 2 cases following the Moderna vaccine1Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney Int. 2021; 99: 1487Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and 2 following the Pfizer BioNTech vaccine.2Rahim S.E.G. Lin J.T. Wang J.C. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination.Kidney Int. 2021; 100: 238Abstract Full Text Full Text PDF Google Scholar,3Tan H.Z. Tan R.Y. Choo J.C.J. et al.Is COVID-19 vaccination unmasking glomerulonephritis [e-pub ahead of print]? Kidney Int.https://doi.org/10.1016/j.kint.2021.05.009Google Scholar As only 1 of these patients had a postvaccination biopsy performed,3Tan H.Z. Tan R.Y. Choo J.C.J. et al.Is COVID-19 vaccination unmasking glomerulonephritis [e-pub ahead of print]? Kidney Int.https://doi.org/10.1016/j.kint.2021.05.009Google Scholar we report the biopsy findings in 2 additional patients who underwent their first kidney biopsy due to the development of gross hematuria shortly following the second dose of the Moderna vaccine for COVID-19.
, Satoru Kudose, Vivette D. D’Agati
American Journal of Kidney Diseases; https://doi.org/10.1053/j.ajkd.2021.06.004

Abstract:
The international deployment of mass vaccinations for coronavirus disease 2019 (COVID-19) has raised new concerns for caregivers who specialize in kidney disease. A number of reports question the ability of transplanted patients on chronic immunosuppression and patients with end stage kidney disease on dialysis to mount sufficient antibody responses to confer immunity against the virus. At the same time, nephrologists are faced with a small but growing literature of case reports linking COVID-19 vaccines with heightened off-target immune responses leading to the sudden development of de novo or relapsing glomerular diseases.
, Xavier Bassand, Ilies Benotmane, Nicolas Bouvier
Published: 31 May 2021
Kidney International, Volume 100, pp 466-468; https://doi.org/10.1016/j.kint.2021.05.022

Abstract:
After the publication of the 2 letters by Negrea and Rovin1Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney Int. 2021; 99: 1487Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar and Rahim et al.,2Rahim SEG, Lin JT, Wang JC. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination [e-pub ahead of print]. Kidney Int. doi:10.1016/j.kint.2021.04.024.Google Scholar we herein describe 3 additional patients with IgA nephropathy (IgAN) who developed gross hematuria after receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA-based vaccines. The clinical data of our cases are summarized in Table 1. In line with the 3 previously reported cases, patient 1 had normal kidney function. However, patients 2 and 3 were treated with kidney transplantation (KT) and hemodialysis, respectively. Notably, gross hematuria developed as early as after the first vaccine dose in patients 1 and 2. Additionally, gross hematuria in patient 1 relapsed after the second vaccine dose. Gross hematuria was sporadically accompanied by increased proteinuria, arthralgia, abdominal pain, and urticaria. Serum creatinine also transiently increased in patient 2. Symptoms spontaneously regressed in all the 3 cases. The apparent exacerbation of IgAN in patient 2 occurred in the absence of an anti–SARS-CoV-2 antibody response. Out of a total of 726 KT recipients, we examined the tolerability of 2 doses of the Moderna vaccine in 80 recipients with IgAN. No additional cases of gross hematuria were identified. Seventy patients had available data on anti–SARS-CoV-2 antibodies 1 month after the second dose, and positive serology was identified in 32 cases (45.7%). This finding is in accordance with our previous data.3Benotmane I. Gautier-Vargas G. Cognard N. et al.Low immunization rates among kidney transplant recipients who received 2 doses of the mRNA-1273 SARS-CoV-2 vaccine.Kidney Int. 2021; 99: 1498-1500Abstract Full Text Full Text PDF PubMed Google ScholarTable 1Patient demographics and clinical characteristicsPatient no.Age, yrSexYear of biopsy-proven IgAN diagnosisTreatmentGFR (ml/min per 1.73 m2) or renal treatmentEpisodes of gross hematuria during the disease coursePersistent microscopic hematuriaProteinuria in 2020, UPR, g/gVaccine NameTiming of gross hematuria occurrence after vaccinationAssociated symptomsProteinuria after the first dose, g/gGFR 1 mo after the second dose, ml/min per 1.73 m2Proteinuria 1 mo after the second doseAnti-spike IgG antibody titers (AU/ml) measured 1 mo after the injection122M2019 (IgA vasculitis)Steroids for 6 mo followed by RAASi89NoYes0.20mRNA-1273 (Moderna)D2 and D25 after the first dose,D2 after the second doseArthralgia, transient proteinuria (3 g/g)0.341070.40NA241F2005Tac, MPA, and steroids for KTKT as of 2013YesYes0BNT162b2 (Pfizer)D2 after the first dose (the patient refused the second dose)Marked leukocytosis0.47570.4114.9aSerology assessment performed 1 mo after the first vaccine dose using the ARCHITECT IgG II Quant test (Abbott). Titers >50 AU/ml were considered positive (detection range, 6.8–80,000 AU/ml).327F2020Steroid for 1 mo followed by RAASiHD since 1 yrNoNo20BNT162b2 (Pfizer)D2 after the second doseAbdominal pain, urticaria at D5, moderate pancytopenia1.9NA1.2>250bSerology assessment performed 1 mo after the second vaccine dose using the Elecsys Anti-SARS-CoV-2 S (Roche). Titers >0.8 U/ml were considered positive (detection range, 0.8–250 U/ml).AU, arbitrary unit; D, day; GFR, glomerular filtration rate; HD, hemodialysis; IgAN, IgA nephropathy; KT, kidney transplantation; MPA, mycophenolic acid; NA, not available; RAASi, renin-angiotensin-aldosterone system inhibitor; Tac, tacrolimus; UPR, urine protein-to-creatinine ratio.a Serology assessment performed 1 mo after the first vaccine dose using the ARCHITECT IgG II Quant test (Abbott). Titers >50 AU/ml were considered positive (detection range, 6.8–80,000 AU/ml).b Serology assessment performed 1 mo after the second vaccine dose using the Elecsys Anti-SARS-CoV-2 S (Roche). Titers >0.8 U/ml were considered positive (detection range, 0.8–250 U/ml). Open table in a new tab
, Ru Yu Tan, Jason Chon Jun Choo, , Chieh Suai Tan, Alwin Hwai Liang Loh, Carolyn Shan-Yeu Tien, Puay Hoon Tan, Keng Thye Woo
Published: 21 May 2021
Kidney International, Volume 100, pp 469-471; https://doi.org/10.1016/j.kint.2021.05.009

Abstract:
We read with great interest the reports of macroscopic hematuria occurring hours following coronavirus disease 2019 (COVID-19) vaccination in patients with known IgA nephropathy (IgAN).1Rahim SEG, Lin JT, Wang JC. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination [e-pub ahead of print]. Kidney Int. https://doi.org/10.1016/j.kint.2021.04.024.Google Scholar,2Negrea L. Rovin B.H. Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy.Kidney Int. 2021; 99: 1487Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar We report 2 previously healthy individuals who presented with macroscopic hematuria shortly after COVID-19 vaccination and were diagnosed with IgAN and crescentic glomerulonephritis, respectively.
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