key: cord-0934050-o2t6tu0q
authors: Tuschen, Katharina; Bräsen, Jan Hinrich; Schmitz, Jessica; Vischedyk, Martin; Weidemann, Alexander
title: Relapse of Class V Lupus Nephritis after Vaccination with COVID-19 mRNA Vaccine
date: 2021-08-02
journal: Kidney Int
DOI: 10.1016/j.kint.2021.07.019
sha: df6aea0a90a48a0b64cb07f6b0580a5e6d79fc89
doc_id: 934050
cord_uid: o2t6tu0q

nan

To the editors Several of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines use a mRNA lipid nanoparticle-encapsulated platform. In experimental models, the induced antibody titers are higher and T-and B-cell responses are enhanced compared to traditional vaccines. Possibly, due to this higher efficacy, more and more kidney specific side effects of mRNA vaccines related to immunemediated glomerular disease are reported [1] [2] [3] Spontaneous remission did not occur in follow-up measurements, and as nephrotic proteinuria persisted for seven weeks, we initiated immunosuppressive therapy with mycophenolate mofetil (1g bid) and prednisolone (60mg qd). As can be seen in figure 1 , proteinuria rapidly declined initially, and the patient reported substantial improvement of her general well-being and the absence of foamy urine. Proteinuria increased again the following week, however with a tendency of an improvement of the absolute amount in the next measurements. ANA titers, which increased after vaccination, also declined after start of therapy. Anti-DNS-antibody levels did not increase after the vaccination, and the slightly below normal C3c-levels increased (figure 1b-d).

The patient had already developed an antibody response against spike protein of SARS-CoV-2 (figure 1), thus we decided to postpone the second vaccination in light of declining incidence numbers. It still remains to be determined, when to proceed with the second vaccination, since full remission of the proteinuria, is not achieved yet.

Our case report is the first to describe a biopsy proven relapse of Lupus nephritis Class V and II. New onset Minimal change glomerulopathies 3, 6 and also other forms of glomerulonephritis (e.g. de-novo IgAN 2 , relapse IgAN 1 and even anti-GBM glomerulonephritis 7 

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