To the Editor:
The timely editorial from Bomback et al1 on de novo and relapsing glomerular diseases after COVID-19 vaccination noted that immunoglobulin A nephropathy (IgAN) was one of the most frequently reported glomerulonephritides in this context. However, the absolute incidence was low, with 10 reports of de novo or relapsed IgAN, including 1 from our institution.2 Vaccine trial safety data in IgAN are lacking in part because immunosuppressed patients, including those with glomerular diseases, were generally excluded.3 We reviewed 145 IgAN patients diagnosed between December 2015 and March 2021 and on active follow-up, and noted that 61.4% had received at least 1 dose of messenger RNA–based COVID-19 vaccine. All patients except 1 (described in2) had pre-existing IgAN diagnosed before their vaccination. None of those with pre-existing IgAN who had COVID-19 vaccination reported gross hematuria at a median 28 (interquartile range, 15-50) days’ follow-up. Among 29 patients with pre-existing IgAN who had kidney function, urine microscopy, and proteinuria evaluated at 11 (18-33) days after vaccination, 2 had mildly increased serum creatinine with increased hematuria and proteinuria. None required initiation or escalation of immunosuppressive therapy. The possibility of a treatable flare after vaccination should be weighed against the significantly increased risk of COVID-19-related mortality in patients with kidney disease.4
Article Information
Support
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Financial Disclosure
The authors declare that they have no relevant financial interests.
Acknowledgements
We thank Hui Zhuan Tan, Zhong Hong Liew, and Irene Mok for contributions to this work.
Patient Protections
Ethics review was not required according to the SingHealth Centralized Institutional Review Board determination (reference number 2021/2356) for this service evaluation, as participants were not subjected to additional risks or burdens beyond usual clinical practice.
Peer Review
Received July 7, 2021. Accepted July 7, 2021 after editorial review by a Deputy Editor.
References
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