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BACKGROUND: Vaccination against COVID-19 has to a great extent contributed to the easing of COVID-19 pandemic. Immune responses to vaccination are a known trigger for new onset of glomerular disease in susceptible individuals. Although it is not possible to conclusively determine the causal relation between vaccination and glomerular diseases, the temporal sequence of events and clinico-pathologic presentation strongly support the hypothesis of vaccine induced immune response. Development of de novo glomerular diseases following COVID-19 vaccination has been reported, and the term COVID-19 Vaccine-Associated Glomerular Disease (CVAGD) has been suggested. Most studies have shown Minimal Change Disease and IgA Nephropathy to be the common glomerular diseases. In this study, we report a different set of glomerular diseases associated with COVID-19 vaccine in this suburban tertiary care center AIM OF THE STUDY: To study the clinicopathologic profile of new onset biopsy-proven glomerular disease within two weeks of receiving COVID-19 vaccine METHODS: This study is a cross-sectional observational analytic study during the period November 2021 to April 2022 at the department of Nephrology Tirunelveli Medical College Hospital. Patients who presented with symptoms and signs of new onset glomerular disease within two weeks of COVID vaccination were studied. After getting informed consent, detailed history taking clinical examination relevant urine and blood investigations was done. Relevant serologic tests like ANA ANCA Anti GBM antibodies were done if indicated. Patients underwent ultrasound guided renal biopsy with biopsy gun and samples sent for light microscopy and immunofluorescence. The biopsy was reported by an expert renal pathologist. Data was collected, and statistical analysis done. RESULT(S): Total number of biopsy-proven de novo glomerular diseases during the study period in this institution was 74. Five patients developed symptoms and signs of glomerular disease within two weeks of covid vaccination and underwent renal biopsy. None of these patients had known prior COVID-19 infection. Three patients had received ChAdOX1-nCOV vaccine, one BBV152, and the other patient BECOV2D vaccine. All patients were females. Two patients developed symptoms after second dose, while three patients developed symptoms after first dose. Syndromic presentation was rapidly progressive glomerulonephritis in two subjects, nephrotic syndrome in two, and nephritic syndrome in one. Three patients were diagnosed as lupus nephritis, one PLA2R negative membranous nephropathy, and one ANCA-associated vasculitis. Two of the three patients with lupus nephritis presented only with renal symptoms, while the other patient presented with predominant renal along with mucocutaneous symptoms. Two patients showed a histologic picture of crescentic glomerulonephritis. All patients have shown good response to appropriate treatment. The commonest cause of CAVGD reported in India and other countries have been IgAN and MCD. Our study population was different in that lupus nephritis was the commonest cause. Though a few cases of new onset SLE after COVID vaccination have been reported, these patients presented with predominant systemic symptoms and signs with no significant renal involvement CONCLUSION(S): We have described a novel cluster of CVAGD in this semiurban tertiary center. Though the benefits of vaccination are undoubtable, side effects also need to be factored. Recognition of CVAGD and prompt management is rewarding.
RESUMO
BACKGROUND: Chronic Kidney Disease (CKD) Stage V patients on hemodialysis are a vulnerable group who have reported high rates of morbidity and mortality with Covid-19 infection. Covid-19 vaccination has been reported to be immunoprotective, and these patients are prioritized for Covid-19 vaccination. It is reported that dialysis patients develop lower seroconversion to vaccines. Indeed, this lower postvaccine response led to the adaptation of hepatitis B and influenza immunization schedules. Data are lacking on the humoral immune response to indigenously manufactured BBV152 (inactive) vaccine. In this study, we estimate the serologic response to BBV152 vaccine in hemodialysis patients in our Nephrology unit AIM OF THE STUDY: 1. To estimate the humoral immune response (conversion from seronegative to seropositive state) to inactivated SARS CoV2 vaccine administered as per The Government of India protocol in CKD stage V patients on maintenance HD 2. To correlate demographic clinical and biochemical/hematologic parameters with the humoral response METHODS: This study was a cross-sectional observational study conducted between September 2021 and March 2022 at the Department of Nephrology Tirunelveli Medical College Hospital. Ethics Committee approval was obtained. All CKD V patients on maintenance HD for at least three months who were willing to take BBV152 vaccine were enrolled in the study. Patients suffering from intercurrent illness those who had a prior PCR confirmed diagnosis of Covid-19, and patients who had positive baseline antibody titers were excluded from the study. Sample size was calculated according to the standard sample size calculator for observational study with a qualitative variable which computed a minimum sample size of 82. Detailed history taking clinical examination hematological and biochemical investigations assessment of nutritional status was performed as per structured questionnaire. For each patient, the following parameters were noted: Age, gender, BMI, native kidney disease comorbidities whether on immunosuppressant drugs, Hb absolute lymphocyte count, ESR serum albumin, and adequacy of dialysis by calculating spKt/V. Patients were then administered two doses of COVAXIN. Antibody titers were measured at baseline and four weeks after the first and second dose. Anti-SARS-CoV-2 IgG antibodies were measured using Access 2 Immunoassay System - Beckman Coulter by Chemiluminescence Microparticle Immunoassay which detects neutralizing antibodies against Receptor-Binding Domain of spike protein with a high sensitivity and specificity. The result of antibody titer was reported as nonreactive or reactive based on S/CO (Signal/Cut-Off ratio). S/CO 0.8 was nonreactive and S/CO 1 was reactive. Data was collected in MS-Excel, and IBM SPSSv26.0 was used for statistical analysis. RESULT(S): A total of 119 patients were enrolled out of which 107 patients completed the study. 75.7% (81 out of 107) patients achieved seroconversion after two doses of BBV152 which is lesser than seen in healthy controls. The rate of seroconversion was 66.4% after the first dose. Analysis of factors associated with poor seroconversion in this study showed increasing age, presence of diabetes, atherosclerotic cardiovascular disease, severe anemia, higher ESR, and severe hypoalbuminemia (Serum albumin < 2.5 g/dl) to be statistically significant. Patients who had lower BMI and spKt/V >1.2 showed a better seropositivity response in this study. HD vintage and absolute lymphocyte counts were not significantly associated with serologic response. Poor seroconversion is generally associated with immunosuppressant therapy, but this was not seen in our study which could be due to the small number (4 patients) in the study. Unique association of diabetes and severe anaemia with poor seroconversion was noted in this study CONCLUSION(S): 75.7% patients on maintenance hemodialysis achieved seroconversion after two doses of inactivated SARS CoV2 BBV152 vaccine. Increasing age, presence of diabetes, atherosclerotic cardiovascular disease, ana mia, inadequate hemodialysis, and hypoalbuminemia were associated with a lesser antibody response to the vaccine in this study. Revising future vaccine strategies with an aim at improving immunologic response in patients on hemodialysis with high-risk factors like diabetes mellitus brought out in our study could prove worthwhile.