IgA vasculitis presenting as nephrotic syndrome, a complication of covid-19 vaccination

A recent study in the BMC Nephrology, by Illeon Cho and team closely warn about the concerns post covid -19 vaccination they state physicians should keep in mind the potential (re)activation of IgA vasculitis following mRNA COVID-19 vaccines and is important to closely monitor COVID-19 vaccinated patients, particularly those with autoimmune diseases.

The global COVID-19 vaccine campaign has been actively underway to overcome the COVID-19 pandemic. Backing up the strong recommendation for coronavirus disease 2019 (COVID 19) vaccination, many patients with medical comorbidities are being immunized. However, the safety of vaccination in patients with autoimmune diseases has not been well established.

There is no diagnostic tool to prove the causality between glomerulonephritis (GN) and mRNA COVID-19 vaccines. However, the consistency of case reports may be related to its pathogenesis and will help to make a hypothesis to prove the causality, which will also help manage kidney disease properly. The efficacy and safety of BNT162b2 and mRNA-1273 have been demonstrated in clinical trials and real-world studies. However, the safety of vaccination in patients with autoimmune diseases has not been well established. The current study evaluates the same.

Researchers in this study report a new case of biopsy-proven IgA vasculitis with nephritis presenting as a nephrotic syndrome after mRNA COVID-19 vaccination in a patient with a history of leukocytoclastic vasculitis.

A 76-year-old man with a history of cutaneous leukocytoclastic vasculitis presented with purpura in both lower limbs, followed by nephrotic syndrome after the second dose of BNT162b2 mRNA COVID-19 vaccination. Skin and renal biopsy revealed IgA vasculitis with nephritis. The patient's past medical history of leukocytoclastic vasculitis and features of chronicity in renal pathology suggest an acute exacerbation of preexisting IgA vasculitis after COVID-19 vaccination. After the steroid and renin-angiotensin system inhibitor use, purpura and acute kidney injury recovered within a month. Subnephrotic proteinuria with microscopic hematuria remained upon follow-up.

`Illeon Cho and team concluded that physicians should keep in mind the potential (re)activation of IgA vasculitis following mRNA COVID-19 vaccines. It is important to closely monitor COVID-19 vaccinated patients, particularly those with autoimmune diseases.

Reference: Cho, I., Kim, JK. & Kim, S.G. IgA vasculitis presenting as nephrotic syndrome following COVID-19 vaccination: a case report. BMC Nephrol 23, 403 (2022). https://doi.org/10.1186/s12882-022-03028-7.