key: cord-0963777-d0eubtq9
authors: Dube, Geoffrey K.; Benvenuto, Luke J.; Batal, Ibrahim
title: ANCA-associated Glomerulonephritis Following the Pfizer-BioNTech COVID-19 Vaccine
date: 2021-08-17
journal: Kidney Int Rep
DOI: 10.1016/j.ekir.2021.08.012
sha: bea88beb1daf577333529da0247afcdba21f2f88
doc_id: 963777
cord_uid: d0eubtq9

nan

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused significant global morbidity and mortality since first emerging as a pathogen at the end of 2019. Acute kidney injury, most commonly due to acute tubular injury, is a frequent finding in COVID-19, occurring in 17-37% of patients. [1] [2] [3] De novo glomerular disease is much less common with COVID-19, although cases of new onset collapsing glomerulopathy, immune-complex glomerulonephritis and ANCA-associated glomerulonephritis have been reported. [4] [5] [6] The development and rapid utilization of several effective vaccines against SARS-CoV-2 has helped reduce spread of the virus in countries able to implement a vaccination program. While the vaccines are well tolerated and major side effects are uncommon, case reports have emerged of rare side effects, including vaccine-induced immune thrombotic thrombocytopenia and minimal change disease. 7, 8 We report here a case of pauci-immune crescentic glomerulonephritis associated with de novo development of antineutrophil cytoplasmic autoantibodies (ANCA) following vaccination with the Pfizer-BioNTech COVID-19 vaccine.

A 29 year-old woman was referred for evaluation of acute kidney injury. She had a history significant for congenital diffuse cystic lung disease, attributed to a mutation in the surfactant Based on the results of her biopsy, she was started on treatment for her ANCA-associated glomerulonephritis with steroids (methylprednisolone 500 mg daily for 3 doses, followed by prednisone 1 mg/kg daily), rituximab (1000 mg for 2 doses, spaced 2 weeks apart), and intravenous cyclophosphamide (500 mg for 2 doses, spaced 2 weeks apart). At last follow up, 10 weeks after her biopsy, her creatinine was 1.01 mg/dL, her albumin to creatinine ratio was 1,393 mcg/mg, her urine showed 0-2 RBCs/hpf, and her MPO-ANCA titer was negative.

Several vaccines have been associated with the development of post-vaccination autoimmune phenomena, including multiple case reports of de novo ANCA-associated vasculitis following seasonal influenza vaccination. 9,S1 To-date, there are a few reports of ANCA-associated glomerulonephritis following both the Moderna and Pfizer COVID-19 vaccines. S2-S4 While there is no definitive test to prove causality, the development of MPO-ANCA in a patient with previous negative testing, acute kidney injury and crescentic glomerulonephritis occurring shortly after vaccination raises suspicion that the two events are more than coincidence. 

Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Acute kidney injury in patients hospitalized with COVID-19

The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria

Kidney Biopsy Findings in Patients with COVID-19

Immune-Complex Glomerulonephritis After COVID-19 Infection

De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19

Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination

Vaccines rarely are associated with the development of post-vaccination autoimmune phenomena

While the SARS-CoV-2 vaccines are exceptionally safe and effective, de novo ANCAassociated glomerulonephritis can be associated with recent COVID-19 vaccination

ANCA-associated vasculitis should be considered in the differential diagnosis of acute kidney injury following COVID-19 vaccination. Abbreviations: ANCA, antineutrophil cytoplasmic autoantibody

The authors of this manuscript have no conflicts of interest to disclose.

Supplementary References (PDF)