ANCA-Associated Vasculitis Following Pfizer-BioNTech COVID-19 Vaccine

Am J Kidney Dis. 2021 Oct;78(4):611-613. doi: 10.1053/j.ajkd.2021.06.016. Epub 2021 Jul 17.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread around the world. As of the end of June 2021, there were approximately 181 million confirmed cases and more than 3.9 million deaths across the globe. The colossal impact of coronavirus disease 2019 (COVID-19) is driving the biggest vaccination campaign in human history. All 3 vaccines authorized for emergency use by the US Food and Drug Administration (Pfizer-BioNTech, Moderna, and Janssen/Johnson & Johnson) have been thoroughly studied and found to be safe and effective in preventing severe COVID-19 cases. While short-term side effects of COVID-19 vaccine resemble those of other vaccines, long-term side effects remain unknown. Rare side effects continue to surface as millions of people receive COVID-19 vaccines around the world, as compared with the thousands enrolled in the clinical trials. We report a case of new-onset renal-limited ANCA-associated vasculitis (AAV) in a 78-year-old woman with previously normal kidney function after receiving the Pfizer-BioNTech COVID-19 vaccine. The patient developed acute kidney injury with proteinuria and microscopic hematuria with many dysmorphic red blood cells in the urine. Anti-myeloperoxidase antibody titer was elevated. Kidney biopsy showed pauci-immune crescentic necrotizing glomerulonephritis. Kidney function improved after treatment with steroids and rituximab. Our patient had normal routine laboratory testing before the vaccination. Although this case cannot demonstrate a causal relationship between COVID-19 vaccination and AAV, ongoing surveillance for similar complications would be prudent as worldwide vaccination efforts continue.

Keywords: ANCA-associated vasculitis; Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); antineutrophil cytoplasmic antibody (ANCA); case report; crescentic necrotizing glomerulonephritis; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); vaccine.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / blood
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / chemically induced*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / diagnosis*
  • BNT162 Vaccine
  • COVID-19 Vaccines / adverse effects*
  • Female
  • Humans


  • COVID-19 Vaccines
  • BNT162 Vaccine