New Onset Biopsy-Proven Nephropathies after COVID Vaccination

Roberta Fenoglio; Stefania Lalloni; Martina Marchisio; Valentina Oddone; Emanuele De Simone; Giulio Del Vecchio; Savino Sciascia; Dario Roccatello

doi:10.1159/000523962

New Onset Biopsy-Proven Nephropathies after COVID Vaccination

Am J Nephrol. 2022;53(4):325-330. doi: 10.1159/000523962. Epub 2022 Mar 30.

Authors

Roberta Fenoglio¹, Stefania Lalloni¹, Martina Marchisio¹, Valentina Oddone¹, Emanuele De Simone¹, Giulio Del Vecchio¹, Savino Sciascia¹, Dario Roccatello¹

Affiliation

¹ University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) including the Nephrology and Dialysis Unit, Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), Department of Clinical and Biological Sciences, San Giovanni Bosco Hub Hospital, University of Turin, Turin, Italy.

Abstract

Introduction: To date, almost 7 billion doses of the different types of vaccine against SARS-CoV-2 have been administered worldwide. Although the severity of new cases of SARS-CoV-2 has progressively decreased, and the pressure on national health systems has declined, the development of de novo glomerular injuries has been suggested.

Methods: This study aimed to examine the patients who were hospitalized in our Unit between April and November 2021 and underwent renal biopsy for new-onset urinary abnormalities (UA) and/or renal impairment within 3 months of SARS-CoV-2 vaccination.

Results: We identified 17 patients who developed UA and/or renal insufficiency within 3 months of vaccination. Minimal change disease was the most common disease in our cohort (5 patients, 29.4%) followed by acute tubulointerstitial nephritis (TIN; 3 patients, 17.6%), membranous nephropathy (3 patients, 17.6%), and rapidly progressive IgA nephropathy (2 patients, 11.8%). The other 4 patients had a diagnosis of membranoproliferative glomerulonephritis (1 patient), systemic lupus erythematosus (1 patient), ANCA-associated vasculitis (1 patient), and tip-variant focal segmental glomerulosclerosis (1 patient), respectively. Eight out of the 17 patients (47.1%) developed acute kidney injury. Two patients with acute TIN had to start hemodialysis that was discontinued after 1 and 2 months, respectively, due to the recovery of renal function. All patients underwent treatment with corticosteroids and/or immunosuppressants.

Discussion: Although it is not possible to conclusively determine whether there is a causal relationship between SARS-CoV-2 vaccination and new-onset nephropathies, based on the appearance of UA and/or renal insufficiency shortly after vaccination, we hypothesize that the immune response to the COVID-19 vaccine may be a trigger of nephropathies. Therefore, our results highlight the need for pharmacovigilance. However, this report should not lead to vaccine hesitation during this pandemic as the benefits of vaccination strongly outweigh the potential risks.

Keywords: COVID vaccination; Glomerulopathies; Interstitial nephritis; Kidney biopsy.

MeSH terms

Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Biopsy
COVID-19 Vaccines / adverse effects
COVID-19* / diagnosis
COVID-19* / epidemiology
COVID-19* / prevention & control
Female
Glomerulonephritis, IGA* / pathology
Humans
Male
SARS-CoV-2
Vaccination / adverse effects

Substances

COVID-19 Vaccines