Table 1.
Clinical spectrums and outcomes of ANCA-associated glomerulonephritis following SARS-CoV-2 vaccination by vaccine type.
| Parameters | Total (n = 29) |
mRNA Vaccine (n = 16) |
Viral Vector Vaccine (n = 9) |
Inactivated Vaccine (n = 4) |
p Value |
|---|---|---|---|---|---|
| Age, years | 70 (22) | 70 (25) | 72 (17) | 69 (33) | 0.63 |
| Female | 17/29 (59%) | 9/16 (56%) | 5/9 (56%) | 3/4 (75%) | 0.88 |
| Vaccination dose | 0.08 | ||||
| ● 1st dose | 9/29 (31%) | 3/16 (19%) | 5/9 (56%) | 1/4 (25%) | |
| ● 2nd dose | 17/29 (59%) | 12/16 (75%) | 2/9 (22%) | 3/4 (75%) | |
| ● 3rd dose or more | 3/29 (10%) | 1/16 (6%) | 2/9 (22%) | 0/4 (0%) | |
| Onset after last vaccination, days | 14 (16) | 14 (24) | 15 (8) | 20 (16) | 0.72 |
| Clinical manifestations | |||||
| ● AKI or RPGN | 14/29 (48%) | 8/16 (50%) | 5/9 (56%) | 1/4 (25%) | 0.76 |
| ● Sub-nephrotic proteinuria/NS | 9/29 (31%) | 3/16 (19%) | 4/9 (44%) | 2/4 (50%) | 0.30 |
| ● Abnormal urine sediments | 19/29 (66%) | 10/16 (62%) | 5/9 (56%) | 4/4 (100%) | 0.40 |
| ● Constitutional symptoms | 15/29 (52%) | 6/16 (38%) | 5/9 (56%) | 4/4 (100%) | 0.10 |
| ● Extra-kidney involvement | |||||
| - Lung (DAH, interstitial pneumonia, etc.) | 8/29 (28%) | 5/16 (31%) | 3/9 (33%) | 0/4 (0%) | 0.62 |
| - NM (muscle weakness, etc.) | 8/29 (28%) | 3/16 (19%) | 4/9 (44%) | 1/4 (25%) | 0.40 |
| - GI (N/V, diarrhea, etc.) | 4/29 (14%) | 1/16 (6%) | 1/9 (11%) | 2/4 (50%) | 0.10 |
| - ENT (hearing loss, tinnitus, etc.) | 3/29 (10%) | 1/16 (6%) | 2/9 (22%) | 0/4 (0%) | 0.70 |
| - Eyes (episcleritis, etc.) | 2/29 (7%) | 1/16 (6%) | 1/9 (11%) | 0/4 (0%) | 1.00 |
| ANCA serologies | |||||
| ● MPO-ANCA/pANCA | 23/29 (79%) | 13/16 (81%) | 7/9 (78%) | 3/4 (75%) | 1.00 |
| ● PR3-ANCA/cANCA | 5/29 (17%) | 3/16 (19%) | 1/9 (11%) | 1/4 (25%) | 1.00 |
| ● pANCA + cANCA | 1/29 (3%) | 0/16 (0%) | 1/5 (8%) | 0/4 (0%) | 1.00 |
| ● Discrepancy positive ANCA | 1/29 (3%) | 0/16 (0%) | 1/6 (17%) | 0/4 (0%) | 1.00 |
| Autoantibodies, n/N (%) | |||||
| ● ANA | 7/11 (64%) | 5/5 (100%) | 1/4 (20%) | 1/2 (50%) | 0.05 |
| ● Coombs/positive anti-globulin test | 3/3 (100%) | 1/1 (100%) | 2/2 (200%) | - | - |
| ● Cryoglobulin | 1/3 (33%) | 1/3 (33%) | - | - | - |
| ● RF | 2/8 (25%) | 0/4 (0%) | 2/3 (67%) | 0/1 (0%) | 0.21 |
| Baseline Scr, mg/dL | 0.9 (0.3) | 0.9 (0.2) | 1.0 (0.7) | 0.8 (0.7) | 0.14 |
| Peak Scr, mg/dL | 4.8 (3.5) | 3.5 (3.7) | 4.8 (2.7) | 5.9 (2.6) | 0.60 |
| De-novo GN | 26/29 (90%) | 15/16 (94%) | 8/9 (89%) | 4/4 (100%) | 1.00 |
| Treatment | |||||
| ● Corticosteroid | 29/29 (100%) | 16/16 (100%) | 9/9 (100%) | 4/4 (100%) | - |
| ● Rituximab | 11/29 (38%) | 9/16 (56%) | 2/9 (22%) | 0/4 (0%) | 0.09 |
| ● Plasmapheresis | 6/28 (21%) | 6/15 (40%) | 0/9 (0%) | 0/4 (0%) | 0.04 |
| ● Hemodialysis | 8/29 (28%) | 2/16 (12%) | 4/9 (44%) | 2/4 (50%) | 0.14 |
| Follow-up time, weeks | 8 (8) | 8 (7) | 14 (10) | 24 (40) | 0.48 |
| Outcomes | 0.65 | ||||
| ● Remission with relapse | 1/28 (3%) | 1/16 (6%) | 0/8 (0%) | 0/4 (0%) | |
| ● Remission without relapse | 24/28 (86%) | 14/16 (88%) | 6/8 (75%) | 4/4 (100%) | |
| ● Non-remission | 3/28 (11%) | 1/16 (6%) | 2/8 (25%) | 0/4 (0%) |
Remarks: Continuous variables were presented with median and interquartile range, while categorical variables were presented with frequency and percentage. Abbreviations: AKI, acute kidney injury; ANCA, antineutrophil cytoplasm antibody; ANA, anti-nuclear antibodies; cANCA, cytoplasmic ANCA; DAH, diffuse alveolar hemorrhage; ENT, ear nose throat; GI, gastrointestinal; GN, glomerulonephritis; MPO, anti-myeloperoxidase; NM, neuromuscular; N/V, nausea/vomiting; PR3, anti-proteinase 3; pANCA, perinuclear ANCA; RPGN; rapidly progressive glomerulonephritis; RF, rheumatoid factor.