Acute kidney injury after Pfizer COVID-19 vaccine due to crescentic fibrillary glomerulonephritis

Clin Nephrol. 2022 Oct;98(4):205-208. doi: 10.5414/CN110855.

Abstract

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease manifesting with proteinuria, renal impairment, hematuria, hypertension, and in a very small proportion can be associated with rapidly progressive glomerulonephritis and, rarely, crescent formation. The main modality for diagnosis is kidney biopsy, which ultrastructurally demonstrates randomly arranged non-branching mesangial and glomerular basement membrane (GBM) fibrils and positive staining for the biomarker DNAJB9. The pathogenesis is largely unknown. It was previously hypothesized to represent an immune-complex-type glomerulonephritis, as most cases show IgG4 restriction. We present the first case of crescentic FGN after mRNA Pfizer vaccine for COVID-19. A strong temporal association between vaccination, elevated creatinine, and diffuse crescentic fibrillary process was found. Immunological, neoplastic, and infectious causes were ruled out. We hypothesized that the vaccine stimulated an immune response that triggered crescentic FGN, however, further investigations will be needed to elucidate the direct role of COVID-19 vaccination in crescentic glomerular disease.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / pathology
  • Biomarkers
  • Biopsy
  • COVID-19 Vaccines / adverse effects
  • COVID-19* / complications
  • COVID-19* / prevention & control
  • Creatinine
  • Glomerular Basement Membrane / pathology
  • Glomerulonephritis* / diagnosis
  • Glomerulonephritis, Membranoproliferative* / pathology
  • HSP40 Heat-Shock Proteins
  • Humans
  • Immunoglobulin G
  • Membrane Proteins
  • Molecular Chaperones
  • RNA, Messenger

Substances

  • Biomarkers
  • COVID-19 Vaccines
  • DNAJB9 protein, human
  • HSP40 Heat-Shock Proteins
  • Immunoglobulin G
  • Membrane Proteins
  • Molecular Chaperones
  • RNA, Messenger
  • Creatinine