Fenoglio R.,Lalloni S., Marchisio M., Oddone V., De Simone E., Del Vecchio G., Sciascia S., Roccatello D.: New Onset Biopsy-Proven Nephropathies after COVID Vaccination. American Journal of Nephrology DOI 10.1159/000523962
The COVID-19 pandemic unleashed a new wave (indeed a torrent) of an old and well-recognized phenomenon; namely, the development of de novo or an exacerbation of underlying kidney disease in subjects receiving vaccinations for prevention of viral or bacterial infectious disease. Administration of any of the vaccines against SARS-CoV-2, the etiologic agent for COVID-19, has been suggested to produce adverse events, including kidney disease, largely based on sporadic case reports or small series. Due to the very widespread use of such vaccines, these adverse events affect only a small minority of subjects receiving these vaccines.
Fenoglio and coworkers conducted a retrospective, time-limited survey of the occurrence of kidney disease following vaccination among hospitalized patients at a single center in Turin, Italy, between April and November 2021. All cases developed kidney disease, either de novo or as a relapse of pre-existing disease (within 3 months of receiving the 1st or 2nd dose of a COVID vaccine). Most (59%) had received the Pfizer BNT162b2 vaccine. Seventeen patients were included out of 123 patients undergoing kidney biopsy during the same interval of time. Seven had nephrotic syndrome, 2 had abnormal urinalyses, and 8 had nephrotic syndrome with progressive kidney function decline. On kidney biopsy, 5 had minimal change disease, 3 had acute tubulointerstitial nephritis (all with acute kidney injury [AKI]), 3 had membranous nephropathy, 2 had IgA nephropathy (IgAN), and one each had membranoproliferative glomerulonephritis, ANCA vasculitis, lupus nephritis, and “tip” lesion focal segmental glomerulosclerosis (FSGS). Eight of the subjects had AKI as the presenting feature. All patients were treated with immunosuppressants (mainly glucocorticoids or rituximab). The age range was 2–82 years. The onset of kidney manifestations ranged from 24 to 89 days after vaccination. There were no African-Americans identified and no cases of collapsing glomerulopathy. De novo disease was seen more frequently after the 2nd dose, while relapsing disease tended to be seen after the 1st dose of vaccine. The mechanism of the adverse events is not known but is thought to be due to augmentation of T- and/or B-cell immune responsiveness. Patients with AKI due to tubulointerstitial nephritis in general recovered, but the long-term Membranous nephropathy (MN) outcomes are not known for those with glomerular disease to short-term follow-up. The actual risk of such adverse events is not well understood due to the lack of information on the number of subjects receiving the vaccines.
This is a valuable contribution as it illustrates the broad spectrum of lesions that can be observed in COVID vaccine-associated nephropathy. Treatment with steroids seems to be effective in AKI with tubulointerstitial nephritis, and immunosuppression might be of value in some cases of de novo or relapsing glomerular disease, but the long-term outcome in these cases is not yet known.