IgA Nephropathy and IgA Vasculitis Post-COVID-19 vaccination: A case-based review

Abstract

Introduction: Vaccination remains the only steadfast defence against severe COVID-19 infection for the foreseeable future. However, with the growing number of case reports describing Vaccine-associated glomerular diseases, including IgA nephropathy (IgAN) or IgA vasculitis (IgAV) associated with COVID-19 vaccination, it becomes pertinent to study the individual diseases in detail. So, we conducted a case-based review of vaccine-associated IgAN/ IGAV. Methods: We undertook a pre-defined literature search of all the published IgAN and IgAV associated with COVID-19 vaccination, along with the description of our case report detailing the clinical, pathological characteristics and treatment-response COVID-19 vaccine-associated IgAN and IgAV. Results: Fifty-one cases (median age 41 years, IQR 30-60)were included, including our case report. mRNA vaccine was the most common among the approved vaccines (86.2%). There were 15 relapses, and 36 were newly diagnosed with IgAN/IgAV. Forty-seven (92.1%) patients had haematuria (28 had gross haematuria), and 37 (72.5%) had proteinuria (4 had nephrotic-range proteinuria). At presentation, the median estimated glomerular filtration rate was 54 ml/min/m2 (IQR 13 to 62). Two (3.9%) patients required haemodialysis, and 21 (41%) patients required immunosuppressive therapy. Twenty-one biopsies had a mesangial hypercellularity (M) score of M1. Nine and one had a Crescent (C) score of C1 and C2, respectively. Three-fourths of the patients had a favourable short-term renal response. presentation of vaccine-associated IgAN/IgAV. Conclusion: Haematuria (either gross or microscopic) is the most common presentation of vaccine-associated IgAN/IgAV. The kidney functions are relatively preserved, and the short-term clinical outcomes are favourable.