Table 1.
Patient demographics and clinical characteristics.
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| Clinical presentation | ||||
| Age, yr/gender | 38/female | 53/male | 59/female | 67/female |
| Medical history | Obesity | HBP, overweight | HBP, Obesity, MPG (2015, CR) | Sjögren, MCD (2020, CR) |
| Vaccine/manufacturer | BBIBP-CorV/Sinopharm | ChaAdOx1 nCoV-19/Oxford-AstraZeneca | Gam-COVID-Vac or Sputnik V/Gamaleya | Gam-COVID-Vac or Sputnik V/Gamaleya |
| Dose (1st/2nd) | 1st | 1st | 1st | 1st |
| Days between vaccine and onset | 7 | 10 | 14 | 6 |
| Symptoms or signs | Asthenia, foamy urine. | Asthenia, foamy urine, edemas. | Foamy urine, edemas. | Foamy urine. |
| BP, mm Hg | 160/100 | 152/94 | 158/96 | 136/78 |
| Laboratory results | ||||
| Serum creatinine, mg/dl | 1.74 | 3.07 | 1.24 | 1.03 |
| Urinary sediment | Hb+, protein+++ | Hb+++, protein+++ | Hb+, protein+++ | Hb+ |
| UPCR, g/g | 9.37 | 4.43 | 5.53 (0.06 prior to vaccination) | 0.44 (0.05 prior to vaccination) |
| Serum albumin, g/dl | 2.8 | 2.9 | 2.5 | – |
| Dyslipidemia | Yes | Yes | Yes | No |
| Immunological studies | ENA+ | All negative | ANA homogeneous (1/160) | – |
| Histopathology report | ||||
| Glomeruli (G) | 8 G; Non globally sclerosed. Diffuse proliferative GN with endocapillary hypercellularity and one cellular crescent. | 13 G; 5 globally sclerosed. Diffuse crescentic GN with 62% fibrocellular crescents. Mesangial and endocapillary hypercellularity. | 16 G; 1 globally sclerosed. Focal proliferative GN | (Biopsy 2020) 4 G; All with preserved size, morphology and cellularity. |
| Tubules and interstitium | Mild IFTA. Mild interstitial inflammation with foamy cells. | Mild acute tubular injury. Moderate IFTA. Mild interstitial inflammation. | Non-significant IFTA. Mild interstitial inflammation. | Non-significant IFTA. |
| Vessels | Mild intimal fibrosis. | Mild intimal fibrosis. | Mild intimal fibrosis. | Mild intimal fibrosis. |
| IF | Dominant glomerular IgA staining | Dominant glomerular IgA staining | No evidence of deposits | No evidence of deposits |
| Electron microscopy | – | – | Glomerular membranes moderately thickened. Podocytes with severe and diffuse pedicellar fusion. | Podocytes with severe and diffuse pedicellar fusion. |
| Treatment | CS+CP | CS+CP | CS | CS |
| Follow up | PR | PR | PR | CR |
ANA, antinuclear antibodies; CP, cyclophosphamide; CR, complete remission; CS, corticosteroids; ENA, antibodies against extractable nuclear antigens; GN, glomerulonephritis; HBP, high blood pressure; Hb, hemoglobin; IFTA, interstitial fibrosis and tubular atrophy; MPG, mesangial proliferative glomerulonephritis; MCD, minimal change disease; PR, parcial remission; UPCR, urine protein-to-creatinine ratio.