Background: The COVID-19 pandemic has led to widespread vaccination with effective results and a great safety profile. However, as the vaccination rate has increased, more cases of autoimmune diseases after the COVID-19 vaccine have been described. We present a systematic review of ANCA-associated glomerulonephritis after the COVID-19 vaccine.
Objectives: To summarize the existing evidence on ANCA-associated glomerulonephritis after the COVID-19 vaccine.
Methods: We searched all studies from inception till January 27, 2022, that described ANCA-associated biopsy-proven glomerulonephritis after COVID-19 vaccine through Embase and Medline. Methodological quality was evaluated with the 4 domains tool. We included 13 patients from 2 case series and 9 case reports. We extracted demographics, history, lab results, outcomes. We then applied descriptive statistics.
Results: 46% of the patients were males and 54% were females. The median age was 74 years. 54% developed symptoms after the second dose of the 2-dose vaccine. The median interval between the vaccine and the symptom onset was 10.5 days. 85% had anti-MPO antibodies, and the rest – anti-PR3 antibodies. 31% of patients had persistent creatinine (Cr) elevation on follow-up, and 3 patients were requiring hemodialysis. Of those 3 patients, 1 patient had normal renal function prior to presentation, and the rest had chronic kidney disease. The summary of the cases is presented in
Gender, age | De novo (1) or relapse (2) | AZD1222 (1), or mRNA-1273 (2), or BNT162b2 (3) | Outcome |
---|---|---|---|
M, 75 1 | 2 | 1 | Hemodialysis |
M, 74 1 | 2 | 1 | Improved Cr |
F, 82 2 | 1 | 2 | Improved Cr |
F, 70 3 | 1 | 2 | Improved Cr |
F, 78 4 | 1 | 3 | Improved Cr |
F, 79 5 | 1 | 3 | Remission |
F, 54 6 | 1 | 3 | Improved Cr |
F, 78 6 | 2 | 3 | Hemodialysis |
M, 58 7 | 1 | 2 | Remission |
M, 63 8 | 1 | 1 | Improved Cr |
F, 29 9 | 1 | 3 | Remission |
M, 52 10 | 1 | 2 | Hemodialysis |
M, 84 11 | 1 | 3 | Worsened Cr |
Conclusion: Although the causality cannot be established on current evidence, the COVID-19 vaccine can probably trigger glomerulonephritis associated with ANCA, primarily anti-MPO type. We need a bigger cohort to identify patients predisposed for disease development or relapse after the COVID-19 vaccine.
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Disclosure of Interests: None declared