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Letter to the Editor
Open Access
Available online 29 October 2021
Glomerulopathies after vaccination against COVID-19. Four cases with three different vaccines in Argentina
Glomerulopatías después de la vacunación frente a COVID-19. Cuatro casos con tres vacunas diferentes en Argentina
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Pehuén Fernándeza,b,
Corresponding author
pehuenfernandez@hotmail.com

Corresponding author.
, María Luján Alayea, María Emilia García Chipleb,c, Javier De Arteagaa,b,d, Walter Douthata,b,d, Jorge De La Fuentea,b,d, Carlos Chiurchiua,b,d
a Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
b Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
c Servicio de anatomía patológica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
d Fundación Nefrológica de Córdoba, Córdoba, Argentina
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Table 1. Patient demographics and clinical characteristics.
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Dear Editor,

After reading some recent reports on the appearance or de novo recurrence of different glomerulopathies after the application of vaccines against COVID-191–10 we would like to contribute our experience.

Four patients (P) previously asymptomatic began with asthenia (P1, P2), foamy urine (all) and edema (P2, P3) within 2 weeks after the first dose of the COVID-19 vaccine (P1: Sinopharm, P2: Oxford-AstraZeneca, P3 and P4: Gamaleya). All presented hypertension and microscopic hematuria. The first three patients also presented with acute kidney injury, nephrotic range proteinuria, hypoalbuminemia and dyslipidemia. The P4 increased his proteinuria significantly. Renal biopsies performed showed two IgA nephropathy with crescent (Supplementary Fig. S1, A–F) and recurrence of proliferative glomerulonephritis (Supplementary Fig. S2, A and B). P4 did not undergo a new biopsy since she had a previous diagnosis in 2020 of minimal change disease (Supplementary Fig. S2, C and D) and it was interpreted as the beginning of a recurrence of her disease. All received corticosteroids and P1 and P2 also received cyclophosphamide. P1, P2 and P3 presented partial remission and P4 complete remission (Table 1).

Table 1.

Patient demographics and clinical characteristics.

  Patient 1  Patient 2  Patient 3  Patient 4 
Clinical presentation
Age, yr/gender  38/female  53/male  59/female  67/female 
Medical history  Obesity  HBP, overweight  HBP, Obesity, MPG (2015, CR)  Sjögren, MCD (2020, CR) 
Vaccine/manufacturer  BBIBP-CorV/Sinopharm  ChaAdOx1 nCoV-19/Oxford-AstraZeneca  Gam-COVID-Vac or Sputnik V/Gamaleya  Gam-COVID-Vac or Sputnik V/Gamaleya 
Dose (1st/2nd)  1st  1st  1st  1st 
Days between vaccine and onset  10  14 
Symptoms or signs  Asthenia, foamy urine.  Asthenia, foamy urine, edemas.  Foamy urine, edemas.  Foamy urine. 
BP, mm Hg  160/100  152/94  158/96  136/78 
Laboratory results
Serum creatinine, mg/dl  1.74  3.07  1.24  1.03 
Urinary sediment  Hb+, protein+++  Hb+++, protein+++  Hb+, protein+++  Hb+ 
UPCR, g/g  9.37  4.43  5.53 (0.06 prior to vaccination)  0.44 (0.05 prior to vaccination) 
Serum albumin, g/dl  2.8  2.9  2.5  – 
Dyslipidemia  Yes  Yes  Yes  No 
Immunological studies  ENA+  All negative  ANA homogeneous (1/160)  – 
Histopathology report
Glomeruli (G)  8 G; Non globally sclerosed. Diffuse proliferative GN with endocapillary hypercellularity and one cellular crescent.  13 G; 5 globally sclerosed. Diffuse crescentic GN with 62% fibrocellular crescents. Mesangial and endocapillary hypercellularity.  16 G; 1 globally sclerosed. Focal proliferative GN  (Biopsy 2020) 4 G; All with preserved size, morphology and cellularity. 
Tubules and interstitium  Mild IFTA. Mild interstitial inflammation with foamy cells.  Mild acute tubular injury. Moderate IFTA. Mild interstitial inflammation.  Non-significant IFTA. Mild interstitial inflammation.  Non-significant IFTA. 
Vessels  Mild intimal fibrosis.  Mild intimal fibrosis.  Mild intimal fibrosis.  Mild intimal fibrosis. 
IF  Dominant glomerular IgA staining  Dominant glomerular IgA staining  No evidence of deposits  No evidence of deposits 
Electron microscopy  –  –  Glomerular membranes moderately thickened. Podocytes with severe and diffuse pedicellar fusion.  Podocytes with severe and diffuse pedicellar fusion. 
Treatment  CS+CP  CS+CP  CS  CS 
Follow up  PR  PR  PR  CR 

ANA, antinuclear antibodies; CP, cyclophosphamide; CR, complete remission; CS, corticosteroids; ENA, antibodies against extractable nuclear antigens; GN, glomerulonephritis; HBP, high blood pressure; Hb, hemoglobin; IFTA, interstitial fibrosis and tubular atrophy; MPG, mesangial proliferative glomerulonephritis; MCD, minimal change disease; PR, parcial remission; UPCR, urine protein-to-creatinine ratio.

Although it is very difficult to prove causation, at the time of this letter there are at least 40 reports of different types of glomerulopathies after receiving the COVID-19 vaccine from different manufacturers (Pfizer, Moderna, AstraZeneca and Sinovac).1–10 To our knowledge, our reports would be the first related to the Sputnik V (Gamaleya) and BBIBP-CorV (Sinopharm) vaccines. Undoubtedly, the benefits of vaccines far outweigh the risks, but these findings emphasize the importance of surveillance in patients with previous glomerulonephritis and/or the appearance of foamy urine, edemas, hypertension or laboratory abnormalities.

Funding

This work has not received any type of funding.

Conflict of interest

The author declares that he has no conflict of interest.

Appendix A
Supplementary data

The following are the supplementary data to this article:

References
[1]
A.S. Bomback, S. Kudose, V.D. D’Agati.
De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far?.
Am J Kidney Dis, (2021),
[2]
C. Hanna, L.P.H. Hernandez, L. Bu, et al.
IgA nephropathy presenting as macroscopic hematuria in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine.
Kidney Int, 100 (2021), pp. 705-706
[3]
K. Park, S. Miyake, C. Tai, M. Tseng, N.K. Andeen, V.L. Kung.
Letter regarding: “a case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination”.
Kidney Int Rep, 6 (2021), pp. 2246-2247
[4]
Y.J. Anupama, R.G. Patel, M. Vankalakunti.
Nephrotic syndrome following ChAdOx1 nCoV-19 vaccine against SARScoV-2.
Kidney Int Rep, 6 (2021), pp. 2248
[5]
V. Gillion, M. Jadoul, N. Demoulin, S. Aydin, A. Devresse.
Granulomatous vasculitis after the AstraZeneca anti-SARS-CoV-2 vaccine.
Kidney Int, 100 (2021), pp. 706-707
[6]
L. Gueguen, C. Loheac, N. Saidani, L. Khatchatourian.
Membranous nephropathy following anti-Covid-19 mRNA vaccination.
[7]
M. Villa, F. Díaz-Crespo, A. Pérez de José, U. Verdalles, E. Verde, F. Almeida Ruiz, et al.
A case of ANCA-associated vasculitis after AZD1222 (Oxford-AstraZeneca) SARS-CoV-2 vaccination: Casuality or causality?.
Kidney Int, 100 (2021), pp. 937-938
[8]
R. Plasse, R. Nee, S. Gao, S. Olson.
Acute kidney injury with gross hematuria and IgA nephropathy after COVID-19 vaccination.
[9]
K. Tuschen, J.H. Bräsen, J. Schmitz, M. Vischedyk, A. Weidemann.
Relapse of class V lupus nephritis after vaccination with COVID-19 mRNA vaccine.
[10]
Y. Da, G.H. Goh, P. Khatri.
A case of membranous nephropathy following Pfizer-BioNTech mRNA vaccine against coronavirus 2019.
Copyright © 2021. Sociedad Española de Nefrología
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