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Case Reports
. 2022 Apr 7;23(1):135.
doi: 10.1186/s12882-022-02769-9.

IgA nephropathy relapse following COVID-19 vaccination treated with corticosteroid therapy: case report

Shota Watanabe  1 , Shuling Zheng  2 , Arash Rashidi  3
Affiliations
Case Reports

IgA nephropathy relapse following COVID-19 vaccination treated with corticosteroid therapy: case report

Shota Watanabe et al. BMC Nephrol. .

Abstract

Background: The flare of immune-mediated disease following coronavirus disease of 2019 (COVID-19) vaccination is a rare adverse event following immunization. De novo, as well as relapsing IgA nephropathy (IgAN) cases, have been reported following either mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccination. To our knowledge, the majority of IgAN relapses did not result in severe acute kidney injury (AKI) and resolved spontaneously.

Case presentation: This is a case of a 54-year-old female with a previous diagnosis of IgAN who developed IgAN relapse following the second dose of Moderna vaccine. Gross hematuria developed 2 days after vaccination, which was accompanied by significant AKI. Kidney biopsy showed mild tubular atrophy and IgA staining in mesangium without crescent formation. Significant improvement in serum creatinine (Cr) was observed on day 10 after initiating prednisone. Cr came back to normal within 3 months after initiating corticosteroid.

Conclusion: COVID-19 vaccination is associated with a flare of IgAN that may cause significant AKI. Steroid therapy is associated with recovery. IgAN flare after COVID-19 vaccination should be closely monitored to elucidate any adverse effect associated with the novel vaccine.

Keywords: AKI; COVID-19 vaccine; Hematuria; IgA nephropathy; Kidney biopsy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Histopathologic findings from renal biopsy. a Light microscopy shows no mesangial or endocapillary hypercellularity, or crescents. Fibrous adhesion to the Bowman capsule is identified focally (black arrow). There is mild interstitial fibrosis and tubular atrophy (original magnification × 10). b Immunofluorescence analysis demonstrates weak IgA staining in mesangium (original magnification × 20). c Immunofluorescence analysis demonstrates negative IgG staining in mesangium (original magnification × 20). d Electron microscopy reveals a small number of mesangial electron-dense deposits, especially underneath paramesangial basement membranes (white arrow). Bar = 1 μm
See this image and copyright information in PMC

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