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American Journal of Kidney Diseases

COVID-19 Vaccination in Immunoglobulin A Nephropathy

      To the Editor:
      The timely editorial from Bomback et al
      • Bomback A.S.
      • Kudose S.
      • D’Agati V.D.
      De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far?.
      on de novo and relapsing glomerular diseases after COVID-19 vaccination noted that immunoglobulin A nephropathy (IgAN) was one of the most frequently reported glomerulonephritides in this context. However, the absolute incidence was low, with 10 reports of de novo or relapsed IgAN, including 1 from our institution.
      • Tan H.Z.
      • Tan R.Y.
      • Choo J.C.J.
      • et al.
      Is COVID-19 vaccination unmasking glomerulonephritis?.
      Vaccine trial safety data in IgAN are lacking in part because immunosuppressed patients, including those with glomerular diseases, were generally excluded.
      • Glenn D.A.
      • Hegde A.
      • Kotzen E.
      • et al.
      Systematic review of safety and efficacy of COVID-19 vaccines in patients with kidney disease.
      We reviewed 145 IgAN patients diagnosed between December 2015 and March 2021 and on active follow-up, and noted that 61.4% had received at least 1 dose of messenger RNA–based COVID-19 vaccine. All patients except 1 (described in
      • Tan H.Z.
      • Tan R.Y.
      • Choo J.C.J.
      • et al.
      Is COVID-19 vaccination unmasking glomerulonephritis?.
      ) had pre-existing IgAN diagnosed before their vaccination. None of those with pre-existing IgAN who had COVID-19 vaccination reported gross hematuria at a median 28 (interquartile range, 15-50) days’ follow-up. Among 29 patients with pre-existing IgAN who had kidney function, urine microscopy, and proteinuria evaluated at 11 (18-33) days after vaccination, 2 had mildly increased serum creatinine with increased hematuria and proteinuria. None required initiation or escalation of immunosuppressive therapy. The possibility of a treatable flare after vaccination should be weighed against the significantly increased risk of COVID-19-related mortality in patients with kidney disease.
      • Zhou F.
      • Yu T.
      • Du R.
      • et al.
      Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

      Article Information

      Support

      None.

      Financial Disclosure

      The authors declare that they have no relevant financial interests.

      Acknowledgements

      We thank Hui Zhuan Tan, Zhong Hong Liew, and Irene Mok for contributions to this work.

      Patient Protections

      Ethics review was not required according to the SingHealth Centralized Institutional Review Board determination (reference number 2021/2356) for this service evaluation, as participants were not subjected to additional risks or burdens beyond usual clinical practice.

      Peer Review

      Received July 7, 2021. Accepted July 7, 2021 after editorial review by a Deputy Editor.

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        De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far?.
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        Is COVID-19 vaccination unmasking glomerulonephritis?.
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        Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
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