A case of membranous nephropathy following Pfizer–BioNTech mRNA vaccination against COVID-19
Authors: Yi Da, Giap Hean Goh, Priyanka Khatri
Journal: Kidney International (2021)

We read a recent report describing the relapse of membranous nephropathy (MN) following the administration of inactivated vaccine against coronavirus disease 2019 (COVID-19).1Aydın M.F. Yıldız A. Oruç A. et al.Relapse of primary membranous nephropathy after inactivated SARS-CoV-2 virus vaccination.Kidney Int. 2021; 100: 464-465Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Here, we describe a case of new-onset MN following vaccination with the Pfizer–BioNTech mRNA-based COVID-19 vaccine. A 70-year-old man with no significant past medical history was referred to our institution for generalized edema, which occurred a week after his first dose of the Pfizer–BioNTech vaccine and got worse a day after the second dose, which was given 3 weeks after the first dose. He denied other symptoms. On examination, his blood pressure was 155/86 mm Hg, and he had bilateral pitting edema up to his thighs. Laboratory tests revealed a serum creatinine level of 114 μmol/l, an albumin level of 17 g/l, a total cholesterol level of 9.24 mmol/l, 17 red blood cells/μl in urine analysis, and a 24-hour total urine protein level of 4.4 grams. Secondary causes, including drugs and infections (hepatitis B, hepatitis C, HIV), were excluded. He was found to have IgM kappa monoclonal gammopathy of undetermined significance. A thorough malignancy screening, including enhanced computed tomography of the thorax, abdomen, and pelvis, gastroscope plus colonoscope, and prostate-specific antigen testing yielded no significant results. A percutaneous kidney biopsy was performed, and diagnosis of MN was confirmed. The results are shown in Figure 1. Serum anti-phospholipase A2 receptor (PLA2R) was negative, and a kidney biopsy stained negative for PLA2R antigen as well. Serum thrombospondin type-1 domain-containing 7A (THSD7A) antibody was positive by indirect immunofluorescence assay. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein antibody was 147.0 U/ml 3 months after his second dose of vaccine. The patient is currently being managed with irbesartan, frusemide, and warfarin. There are no signs of spontaneous remission after 2 months. Our observation, together with other case reports of MN development post–COVID-19 infection,2Elcioglu O.C. Artan A.S. Mirioglu S. et al.COVİD-19 infection in a membranous nephropathy patient treated with rituximab.CEN Case Rep. 2021; 10: 83-87Crossref PubMed Scopus (7) Google Scholar,3Miao J. Fidler M.E. Nasr S.H. et al.Membranous nephropathy in a patient with coronavirus disease 2019 (COVID-19): a case report.Clin Nephrol Case Stud. 2021; 9: 11-18Crossref PubMed Google Scholar and MN relapse post–COVID-19 vaccine administration,1Aydın M.F. Yıldız A. Oruç A. et al.Relapse of primary membranous nephropathy after inactivated SARS-CoV-2 virus vaccination.Kidney Int. 2021; 100: 464-465Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar supports a possible immune dysregulation process causing loss of tolerance to certain podocyte antigens. Elucidation of this possibility requires further studies. Relapse of primary membranous nephropathy after inactivated SARS-CoV-2 virus vaccinationKidney InternationalVol. 100Issue 2PreviewCoronavirus disease 2019 (COVID-19) vaccine is one of the most effective public health interventions to end the COVID-19 outbreak. There are insufficient data on the use of COVID-19 vaccines in patients with autoimmune disease, but vaccines appear to be safe, and experience from previous vaccine studies does not indicate an increased risk of relapse/recurrence.1 However, theoretically, unwanted immunologic events, such as autoimmunity, may be triggered by vaccines. We describe a patient with membranous nephropathy (MN) who stayed in remission for 8 years and experienced a relapse after vaccination with a purified inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus vaccine called CoronaVac (produced in China by Sinovac). Full-Text PDF COVID-19 vaccination followed by activation of glomerular diseases: does association equal causation?Kidney InternationalVol. 100Issue 5PreviewTo date, >4 billion doses of the various severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been administered worldwide in response to the coronavirus disease 2019 (COVID-19) pandemic. Even as widespread vaccination campaigns have contributed to declining case rates, adverse events are appearing beyond those originally reported in the clinical trials of vaccine efficacy and safety. Of particular relevance to the kidney is the increasing number of reports of de novo or reactivation of glomerular diseases (Table 11–25). Full-Text PDF