Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 32  |  Issue : 6  |  Page : 1831--1832

Membranoproliferative Glomerulonephritis following the Oxford AstraZeneca COVID-19 Vaccine


Kawtar Hassani, Majdouline Errihani, Mohamed Houssein Mahamoud, Driss ElKabbaj 
 Department of Nephrology, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V, Mohamed V University in Rabat, Rabat, Morocco

Correspondence Address:
Dr. Kawtar Hassani
Department of Nephrology, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V, Mohamed V University in Rabat, Rabat
Morocco




How to cite this article:
Hassani K, Errihani M, Mahamoud M, ElKabbaj D. Membranoproliferative Glomerulonephritis following the Oxford AstraZeneca COVID-19 Vaccine.Saudi J Kidney Dis Transpl 2021;32:1831-1832


How to cite this URL:
Hassani K, Errihani M, Mahamoud M, ElKabbaj D. Membranoproliferative Glomerulonephritis following the Oxford AstraZeneca COVID-19 Vaccine. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Oct 6 ];32:1831-1832
Available from: https://www.sjkdt.org/text.asp?2021/32/6/1831/352451


Full Text

To the Editor,

We report the first case of membranoproliferative glomerulonephritis (MPGN) with severe acute kidney injury following the Oxford AstraZeneca coronavirus disease 2019 (COVID-19) vaccine. A 55-year-old woman presented with headache and vomiting one week after receiving the second dose of Oxford AstraZeneca COVID-19 vaccine, the Indian version vaccine, on May 30, 2021.

Her medical history included hypertension, controlled by amlodipine with normal routine kidney checkup. She had no prior history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or chronic kidney disease. Headache started the day after her second vaccine and was associated to vomiting, oliguria, and gross hematuria the week after. The laboratory results showed a creatinine level of 10.5 mg/dL (baseline 0.9 mg/dL, one year prior), blood urea nitrogen of 2 g/L, potassium of 5.5 mEq/L, bicarbonate of 17 mEq/L, and hemoglobin of 12.5 g/dL with nephrotic syndrome (protein-creatinine ratio was 4 g/g). Polymerase chain reaction for SARS-CoV-2 was negative. Renal ultrasound was normal. Levels of complement components C3 and C4 were low (C3 = 0.45 g/L C4 = 0.02 g/L). Immunological testing for cryoglobulinemia, antineutrophil cytoplasmic autoantibodies, anti-glomerular basement membrane (GBM) antibodies, antinuclear, and anti doublestranded DNA antibody were negative. Tests for human immunodeficiency virus and hepatitis B and C virus were negative. Protein electrophoresis with immunofixation was normal. No tumor neither infection was found in the computed tomography, cardiac ultrasound, and blood culture. The patient remained with oliguria and the creatinine worsened to 12 mg/dL so dialysis was started. A kidney biopsy [Figure 1] revealed a diffuse endo-capillary proliferation, with double contours of GBM in 12 glomeruli and cellular segmental crescents in five glomeruli, no intra-capillary thrombi were seen with some tubular injury, mild interstitial fibrosis, and fibrous endarteritis.{Figure 1}

Immunofluorescence showed mesangial and parietal granular deposits of polyclonal immunoglobulin G, A, M, and C3. A diagnosis of immunoglobulin-mediated MPGN was made. Pulse of steroids was begun, followed by oral prednisolone, with pulse of cyclophosphamide 10 mg/kg each 14 days for the three first pulses then one pulse each three weeks. At present, she had received five pulses of cyclophosphamide with resumption of urine flow and improvement of renal function. In the last laboratory test, creatinine was at 2.9 mg/dL (estimated glomerular filtration rate = 18 mL/min/1.73 m2) with normal level of the complement components and dialysis was withdrawn.

Adverse events after COVID-19 vaccination are rare but may occur. Cases of minimal change disease (MCD) de novo and relapsing of known MCD have been reported following the Pfizer-BioNTech vaccine and Oxford, AstraZeneca vaccine.[1]

Other publications reported gross hematuria,[2] a case of ANCA glomerulonephritis two weeks after receiving the second dose of Moderna vaccine,[3] and one case of membranous nephropathy two weeks after the first Sinovac vaccine dose.[4]

To our knowledge, this is the first-reported case of MPGN following the COVID-19 vaccine. It has been reported with COVID-19 infection. Several hypotheses can be formulated on how a vaccine could trigger MPGN, a potential mechanism that probably does not implicate a direct effect of the vaccine itself.[5]

It is possible that the enhanced immune response after a second dose could be responsible for triggering the activation of the classical pathway of complement and the deposition of complement factors of the classical pathway and terminal complement pathway in the mesangium and along the capillary wall.[6] It is difficult to prove causality in this case as well as in others cases previously published; it might only be a coincidence but we should be aware of this potential complication of COVID-19 vaccination and all these cases must be notified.

Conflict of interest: None declared.

References

1Leclerc S, Royal V, Lamarche C, Laurin LP. Minimal Change Disease With Severe Acute Kidney Injury Following the Oxford-AstraZeneca COVID-19 Vaccine: A CASE Report. Am J Kidney Dis 2021;78:607-10.
2Rahim SEG, Lin JT, Wang JC. A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination. Kidney Int 2021;100:238.
3Sekar A, Campbell R, Tabbara J, Rastogi P. ANCA glomerulonephritis after the Moderna COVID-19 vaccination. Kidney Int 2021;100: 473-4.
4Carr EJ, Kronbichler A, Graham-Brown M, et al. Systematic Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients with Chronic Kidney Disease. Kidney Int Rep 2021;6:2292-304.
5Tan HZ, Tan RY, Choo JC, et al. Is COVID-19 vaccination unmasking glomerulonephritis? Kidney Int 2021;100:469-71.
6Pramod S, Kheetan M, Ogu I, Alsanani A, Khitan Z. Viral Nephropathies, Adding SARS-CoV-2 to the List. Int J Nephrol Renovasc Dis 2021;14:157-64.