key: cord-0843825-5gp62h7z
authors: Gul Rahim, Shab E.; Lin, Jonathan; Wang, John C.
title: A case of gross hematuria and IgA Nephropathy Flare up following SARS-CoV-2 vaccination
date: 2021-04-28
journal: Kidney Int
DOI: 10.1016/j.kint.2021.04.024
sha: c121036ea8b0272d9a983ff3412a9f055d20e5c4
doc_id: 843825
cord_uid: 5gp62h7z

nan

2. Department of Nephrology, Rogosin Institute, New York, New York, United States. 3 . Department of Nephrology. Rogosin Institute, New York, New York, United States.

To the editor,

We read with great interest L. Negrea, et al's report of 2 cases of IgA nephropathy (IgAN) with gross hematuria following the Moderna vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 . We also cared for a 52-year-old Asian female with prior biopsy-proven IgAN who developed gross hematuria within 24 hours of receiving a second dose of the Pfizer vaccine. Table 1 summarizes clinical data. Her work-up was notable for proteinuria of 4.2g/g of creatinine with serum creatinine at baseline. Of note, SARS-CoV-2 antibody testing prior to vaccination was negative, and she developed no symptoms after the first vaccine dose. Repeat testing within 1 week demonstrated resolution of hematuria and improving proteinuria. Interestingly, she developed gross hematuria following the first shot of the Shingrix vaccine 2 years prior but no symptoms following annual influenza vaccinations. The IgAN flare in our patient following the second SARS-CoV-2 vaccine dose without known prior exposure to SARS-CoV-2 suggests it was mediated by a delayed-type hypersensitivity reaction. Vasculitis flare-ups following vaccinations have been reported in the past 2,3 .

Our patient's symptoms improved within a week without any intervention aside from continued Renin angiotensin aldosterone system (RAAS) blockade. It has been reported that severe COVID-19 illnesses can trigger IgA response in the bronchial mucosa 4 . However, it is unclear how a non-mucosal vaccine triggers this response. We suggest that nephrologists closely follow their patients after COVID-19 vaccination to evaluate for varying degrees of flares, particularly after the second dose of an mRNA vaccine without prior exposure to SARS-CoV2. 

Gross Hematuria Following Vaccination for SARS-CoV2 in Two Patients with IgA Nephropathy. Kidney international

Henoch-Schonlein Purpura Following a Meningococcal Vaccine

Henoch-Schönlein purpura in a renal transplant recipient with prior IgA nephropathy following influenza vaccination

Severe Coronavirus Disease 2019 (COVID-19) is Associated With Elevated Serum Immunoglobulin (Ig) A and Antiphospholipid IgA Antibodies