Outcomes of Covid-19 Vaccine-Associated Glomerular Diseases (CVAGD) – A Case Series from India

Abstract

Background Several cases of glomerular diseases following Covid-19 vaccination, especially mRNA vaccines, have been reported. However, there is little data on glomerular diseases associated with the two vaccines widely available in India (Covaxin and Covishield) and their long-term outcomes. Materials and Methods This was a prospective observational study conducted between May 2021 and May 2023. Patients with new-onset or relapse of proteinuria, hematuria, or renal failure within 30 days of Covid-19 vaccination were included. Data on pre-existing renal disease, vaccine type, symptomatology, laboratory reports, kidney biopsy findings, and treatment details were collected. The clinical course and long-term renal outcomes were studied. Results Sixteen patients with Covid-19 vaccine associated glomerular disease (CVAGD) were studied. The median age was 28 years (IQR 20.5–40) and median time of symptom onset was 14 days (IQR 10–16.5) after vaccination. Renal syndromes at presentation were nephrotic syndrome in seven patients (43.75%), nephritic syndrome in seven patients (43.75%), and rapidly progressive renal failure in two patients (12.5%). Kidney biopsy revealed minimal change disease in five patients (31.2%); IgA nephropathy in four patients (25%); C3 glomerulopathy, lupus nephritis, and focal segmental glomerulosclerosis in two patients each (12.5%); and pauci-immune glomerulonephritis (ANCA-associated vasculitis) in one patient (6.25%). Eleven patients were treated with immunosuppressive drugs. Median duration of follow-up was 20 months (IQR 18–21). At last follow-up, 11 patients had complete recovery of renal failure and proteinuria and 4 patients had partial recovery. Conclusion The most common lesions in this series were minimal change disease and IgA nephropathy. The overall long-term outcome of CVAGD appears good.