#5861 NEW-ONSET OR EXACERBATIONS OF GLOMERULONEPHRITIS FOLLOWING SARSCOV2 VACCINE: A REVIEW OF THE LITERATURE
Authors: Rimoldi Chiara , Vecchio Lucia Del , Magatti Mariagiulia , Allinovi Marco , Gallelli Beniamina , D'amico Marco , Uraghi Sarah , Bella Giulio Pucci , Melfa Gianvincenzo 
Published: June 2023

Abstract

Background and Aims
Following vaccination against SarsCoV2 several cases of new-onset glomerulonephritis or exacerbations of glomerular diseases have been reported [1, 2]. No literature review has been published yet on the subject.

Method
We searched for single case or case series through the PubMed portal search and through the abstract search submitted to the EDTA and the American Society of Nephrology in 2021 and 2022 (last view on the 15th of December 2022).

Results
A total of 138 cases were analyzed, of which 127 complete for all the variables. The mean age was 52.6±20.75 years (min 12, max 99), M/F 67/63. The majority of patients received mRNA vaccine (BNT16b2 Pfizer (n = 70, 51%), mRNA-1273 Moderna (n = 42, 30.7%), followed by AZD1222 AstraZeneca (n = 10, 7.3%) and Ad26.COV2.S Johnson & Johnson (n = 4, 2.9%). A minority of cases were associate with Covaxin and Sinovac (Figure 1). Most cases were reported from the European continent (39.4%, n = 54), followed by North America (35.8%, n = 49) and Asia (21.9%, n = 30). A minority of cases were reported from Australia and Central/South America. The onset of glomerulonephritis occurred after a mean of 17.8 days±22.82 (min 1, max 89). In 37.4% of cases (n = 49), glomerulonephritis occurred after the first dose, in 61.8% after the second (n = 81), only 1 case after the third one. Regarding mRNA vaccine, in most cases, the disease occurred after the second dose (n = 78, 70.9% of cases, p&lt;0.001). Gross hematuria as the initial symptom was significantly related to mRNA vaccination (27/27 cases). 30 cases (24.8%) showed nephrotic syndrome at onset. The most prevalent diagnosis was IgA nephropathy (n = 36, 26.3%), followed by vasculitis (n = 33, 24%), Minimal Change Disease (n = 26, 19%), and membranous nephropathy (n = 14, 10.2%) (Figure 2). Interesting, 6 cases (4.4%) of anti-GBM GN were reported. Compared to patients with glomerulonephritis, those with systemic vasculitis were older (59.84±19.43 vs 49.21±21.21 years), with a slightly shorter onset time (14.9±12.67 days, vs 16.6±24.14 days). Both vasculitis and glomerulonephritis generally occurred more frequently following mRNA vaccination. For vasculitis, ANCA-MPO was more frequent (n = 15, 45.45%), followed by ANCA PR3 (n = 10, 30.3%), and finally IgA vasculitis (n = 3,9%). Two cases (6.06%) were ANCA negative. New-onset glomerulonephritis accounted for 78.8% (n = 108), while relapses accounted for 21.2% (n = 29). There was no significant difference between the type of vaccine and de-novo or relapse glomerulonephritis. Patients were treated with steroid only (43.4%, n = 56), steroid and immunosuppressant (n = 21,16.3%), rituximab alone or in combination (n = 26, 20.15%), conservative therapy (24, 18.6%). 6 patients (4.4%) underwent dialysis, 2.9% (n = 4) received plasmapheresis. 80 patients (69%) responded effectively to therapy, achieving complete remission, 19% (n = 22) achieved partial remission, while 2.1% (n = 14) did not respond to therapy. Evolution towards ESKD occurred in 11 cases (8%).

Conclusion
New-onset glomerulonephritis or exacerbations of glomerular diseases that were in remission is a possible complication of SarsCov2 vaccination. Most patients received mRNA vaccine; more than half of the patient developed or worsened the GN after the second dose.