To the editor:Several reports of newly diagnosed or relapses of immune-mediated renal diseases following vaccination with anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA and AstraZeneca vaccines recently emerged in the litterature.,We report the case of a 77-year-old man who developed an acute granulomatous nephritis associated with vasculitis after the first dose of the AstraZeneca vaccine. The patient had no significant medical history, and serum creatinine (SCr) was 1.2 mg/dl a month before vaccination with a protein-to-creatinine ratio at 0.07 g/g (N = 0.15) of creatinine. Four weeks after injection, the patient presented with fever, night sweating, and anorexia. He was not taking any medication. Laboratory tests revealed acute kidney injury (SCr, 2.7 mg/dl), normal proteinuria, no hematuria, and a C-reactive protein (CRP) level of 200 mg/L. Nasopharyngeal swab for SARS-CoV-2 was negative by polymerase chain reaction, as were anti–SARS-CoV-2 and anti-neutrophil cytoplasmic antibodies (repeated twice 15 days apart). Fluorine-18-fluorodeoxyglucose positron emission tomography scan showed diffuse hypermetabolism of medium vessels, suggesting vasculitis. The kidney biopsy revealed diffuse interstitial edema with noncaseating nonnecrotizing granulomas around small vessels (Figure 1); one showed fibrinoid necrosis. There were no immune deposits. Serum QuantiFERON for tuberculosis was negative, and there were no radiological or biological findings suggestive of sarcoidosis. The patient was started on methylprednisolone, with normalization of SCr and CRP levels within 4 weeks. Interestingly, the patient eventually mounted a humoral response 8 weeks after vaccination.

Figure 1(a,b) On light microscopy, the renal parenchyma is infiltrated by chronic interstitial inflammatory cells and poorly formed granulomas (stars). Some of these granulomas surrounded small vessels, which rarely showed segmental fibrinoid necrosis (arrows). Glomeruli are normal. (a) Jones silver stain, original magnification ×20; (b) Masson trichrome stain, original magnification ×40.

The association of vasculitis with influenza and pertussis vaccines has already been described but without granulomatous pattern.3Vaccine-associated kidney diseases: a narrative review of the literature. Although causality between the renal lesions and the AstraZeneca vaccine cannot be definitively proven, the timing—and the absence of other causes—makes the link between the 2 plausible.4Shah S. Carter-Monroe N. Atta M.G. Granulomatous interstitial nephritis.References

Morlidge C, El-Kateb S, Jeevaratnam P, Thompson B. Relapse of minimal change disease following the AstraZeneca COVID-19 vaccine [e-pub ahead of print]. Kidney Int. https://doi.org/10.1016/j.kint.2021.06.005.

Masset C, Kervella D, Kandel-Aznar C, et al. Relapse of IgG4-related nephritis following mRNA COVID-19 vaccine [e-pub ahead of print]. Kidney Int. https://doi.org/10.1016/j.kint.2021.06.002.

Vaccine-associated kidney diseases: a narrative review of the literature.

Saudi J Kidney Dis Transpl. 30: 1002-1009Shah S. Carter-Monroe N. Atta M.G.

Granulomatous interstitial nephritis.

Clin Kidney J. 8: 516-523Article InfoPublication History

Published online: July 04, 2021

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DOI: https://doi.org/10.1016/j.kint.2021.06.033

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© 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

ScienceDirectAccess this article on ScienceDirect Linked ArticleRelapse of minimal change disease following the AstraZeneca COVID-19 vaccine

Kidney International

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Anecdotal reports linking minimal change disease (MCD) to vaccinations possibly due to immune dysregulation,1 including influenza vaccine,2 pneumococcal,3 meningococcal C vaccines,4 and BNT162b2 coronavirus disease 2019 (COVID-19) vaccine (Pfizer-BioNTech)5,6 have been published. We report 2 cases of biopsy-proven MCD relapsing within 2 days of receiving an AstraZeneca COVID-19 vaccine.

Full-Text PDF Relapse of IgG4-related nephritis following mRNA COVID-19 vaccine

Kidney International

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is currently recommended for patients with chronic kidney disease and immunocompromised patients because their risk of developing severe forms of coronavirus disease 2019 (COVID-19) is higher than other patients. Several reports have highlighted the increased risk of immune disease recurrence following mRNA vaccination, including minimal change disease, membranous nephropathy, or even acute allograft rejection.1,2 We report the case of a 66-year-old man who was diagnosed with IgG4-related disease (IgG4-RD) nephritis in December 2019.

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