key: cord-0913259-y0gmhuq7
authors: Hanna, Christian; Herrera Hernandez, Loren P.; Bu, Lihong; Kizilbash, Sarah; Najera, Lydia; Rheault, Michelle N.; Czyzyk, Jan; Kouri, Anne M.
title: IgA Nephropathy presenting as macroscopic hematuria in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine
date: 2021-07-05
journal: Kidney Int
DOI: 10.1016/j.kint.2021.06.032
sha: 4927bdae8cba370c7ee8c6d6ccc30a131ff72e45
doc_id: 913259
cord_uid: y0gmhuq7

nan

To the editor:

With great interest, we read the recent reports of IgA nephropathy (IgAN) flare-up presenting as macroscopic hematuria, following the second dose of coronavirus disease 2019 (COVID-19) vaccination in adult patients. 1, 2, 3, 4 The United States Food and Drug Administration granted an emergency use authorization (EUA) for the Pfizer-BioNtech-COVID-19 vaccination in December 2020 for individuals 16 years of age and older; the EUA was recently expanded to include children ages 12 to 15 years on May 10, 2021. Here, we report two pediatric patients with IgAN presenting with macroscopic hematuria less than 24 hours after Pfizer COVID-19 vaccination. Neither patient had COVID-19 infection prior to vaccination nor any prior history of reactions to any vaccinations. See Table 1 for clinical information.

The first patient is a 13-year-old male with a history of type 1 diabetes mellitus and known IgAN (Supplementary Figure S1 ). His initial IgAN diagnosis was made six months prior to this event during an evaluation for sub-nephrotic proteinuria and microscopic hematuria with normal renal function, and he was receiving treatment with lisinopril. Within twenty-four hours following the second dose of the COVID-19 vaccine, he developed new-onset gross hematuria and acute kidney injury. His gross hematuria self-resolved and his kidney function recovered without intervention within one week.

The second patient is a previously healthy 17-year-old male who presented with newonset gross hematuria, proteinuria, and acute kidney injury less than 24 hours following the second dose of the vaccine. He had no family history of autoimmune disease, and he was not taking any medications. His gross hematuria self-resolved, but his kidney insufficiency persisted. Kidney biopsy performed 9 days later was consistent with IgAN with cellular glomerular crescents and moderate to severe tubulointerstitial scarring (Supplementary Figure   S2 ), suggesting an acute exacerbation of pre-existing IgAN. He received intravenous methylprednisolone pulses and follow up serum creatinine level showed improvement.

The mechanism by which COVID-19 vaccination may be associated with IgAN flares is unclear. We concur with previous authors' statements that patients, including children, with IgAN should be monitored closely following COVID-19 vaccine, and COVID-19 vaccination may unmask previously undiagnosed glomerulonephritis in pediatric patients. 1 Serum Albumin (g/dL) --Day 9: 3.8

Urine protein-tocreatinine ratio (mg/mg) --Day 9: 1.75

Oxford MEST-C score --Day 9: M1 E1 S1 T1 C1 Treatment --Day 9: 1 gram intravenous methylprednisolone daily x3 followed by oral prednisone 

A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination

Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy

Gross hematuria following SARS-CoV-2 vaccination in patients with IgA nephropathy

Is COVID-19 vaccination unmasking glomerulonephritis? Kidney international