The evaluation, even in the presence of IgA nephropathy, in favor of vaccination against the Sars-Cov2 virus. What do we know from studies
My husband suffers from Berger’s syndrome (kidney disease characterized by the accumulation of a particular type of antibodies, ed) and was advised to refrain from any vaccine, including the one against Covid. We are told that if the autoimmune process were to be reactivated, renal failure could develop. I’m worried: what do you recommend?
He answers Arrigo Schieppatiresearcher at the Rare Diseases Regional Network Coordination Center, Mario Negri IRCCS Pharmacological Research Institute, Bergamo (GO TO THE FORUM)
Since the start of the mass vaccination campaign, several immune-mediated reactions have been reported, such as cases of myocarditis and cases of glomerulonephritis. IgA nephropathy (IgAN), or Berger’s disease, is the most often reported form: cases of already affected people who have had a recurrence of gross hematuria, and proteinuria, and cases detected for the first time have been described. The latter may already be suffering from mild forms of the disease they were unaware they had. A consideration must be made immediately: to establish how frequent this type of complication could be in patients with IgAN, we should not only know how many cases have been reported, but also how many patients with the disease have been vaccinated without problems. In other words, to establish a frequency we should have a numerator (reported cases) and denominator (all vaccinated IgAN patients). This second number, which is almost certainly very large, is completely unknown and therefore we cannot venture hypotheses on the dimensions of the phenomenon; probably rare, if not very rare.
Post vaccination glomerulonephritis
Among the various reports reported in the literature, a very recent one was published by three Nephrology centers in Minnesota and North Dakota (United States). Nephrologists described the baseline characteristics, vaccine type, and clinical outcomes of 13 patients who had re-diagnosed or relapsed glomerulonephritis after vaccination. Of the 13 patients, 8 had a new diagnosis and 5 had a relapse. The average age was 62. IgA nephropathy was the most common in the series (5 of 13 patients, 4 new and 1 relapse) followed by membranous nephropathy (3 patients). In the rest of the literature so far 11 IgAN cases (4 new and 7 relapses). Macroscopic hematuria was the most common presentation, followed by a rise in creatinine. However, in most patients, gross hematuria was often self-limited and rarely required immunosuppressive therapy. Of the total of 16 patients, only 3 received therapy. All relapsing IgA cases spontaneously improved within 1 to 2 weeks.
The complications of Covid
In other words, the outcome of these nephropathies, both newly diagnosed and relapsed, post-Covid vaccine seems favorable. According to the authors, these reports should not question the indication to be vaccinated, even in the presence of a known glomerular nephropathy. It is important that nephrologists and other physicians are aware of this possible occurrence and remain vigilant when evaluating patients after vaccination. Moreover cases of new / relapsed IgAN have also been reported in association with Covid disease, whose short- and long-term complications can be devastating. In the literature there are currently no reports of recurrence of glomerular disease following the administration of the booster dose, whether this was performed with the same vaccine, or with another vaccine. No one can therefore predict what might happen to her husband if she undergoes the vaccination. Experience, limited and very heterogeneous, suggests that choose the lesser evil and an evaluation of the risk-benefit ratio of vaccination, even in the presence of an IgA nephropathy, in favor of the benefit.
March 8, 2022 (change March 8, 2022 | 23:25)
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