AstraZeneca COVID-19 Vaccine Tied to AAV-related Kidney Damage

Case of 51-year-old woman with no known history of kidney disease described

Teresa Carvalho, MS avatar

by Teresa Carvalho, MS |

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The AstraZeneca COVID-19 vaccine may have triggered kidney inflammation linked to ANCA-associated vasculitis (AAV) in a 51-year-old woman, according to a case report.

“Due to the temporal association between the application of ChAdOx1 nCoV-19 vaccine and the onset of renal [kidney] function decline in a previously healthy patient, it is possible to establish a causal relationship,” its authors wrote. “In addition, there have been reports of similar cases after the administration of RNA vaccines, which reinforces the association.”

The report, “SARS-CoV-2 vaccination as a trigger for perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) associated with rapidly progressive glomerulonephritis,” was published in Cureus.

AAV is a group of autoimmune disorders marked by inflammation in small blood vessels that’s typically driven by anti-neutrophil cytoplasmic autoantibodies (ANCAs) — self-reactive antibodies (autoantibodies) that bind to proteins in immune cells called neutrophils.

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In most patients, inflammation occurs in blood vessels in the kidneys. Inflammation and swelling in the glomeruli — the kidneys’ filtering units — causes ANCA glomerulonephritis, a condition that can impair kidney function and lead to kidney failure.

Although it’s clear how AAV damages the body, the factors causing immune system impairment are not known. Research points to a combination of genetics and environmental factors, such as exposure to pollutants, drugs, and microbial infections.

Some studies have reported an association between vaccines and AAV, namely the flu vaccine and, more recently, messenger RNA (mRNA) COVID-19 vaccines.

Researchers in Mexico City described the case of a woman who developed ANCA-associated glomerulonephritis after receiving the adenovirus vector COVID-19 vaccine developed by AstraZeneca.

The woman, who had no history of kidney disease, had fever, nausea, lack of energy, loss of appetite, and muscle and joint pain after receiving the third dose of the vaccine.

After being treated for those symptoms, she lost 7 kg (15.4 pounds) in a month. Lab tests showed high levels of creatinine (1.3 mg/dL; normal range: 0.6 to 1.1 mg/dL) and urea (39 mg/dL; normal range: 6 to 24 mg/dL) in the blood, as well as the presence of white blood cells and proteins in urine, suggestive of kidney disease.

Based on these findings, she was given antibiotics and paracetamol, but her symptoms didn’t resolve. After her creatinine and urea levels escalated (to 3.99 mg/dL and 99 mg/dL, respectively), she was admitted to the emergency unit, where they increased again to 4.98 mg/dL and 114 mg/dL, respectively.

No skin lesions or edema were found during a physical examination, but levels of proteins and blood cells in the urine had increased. Further testing showed the woman had no cytoplasmic (c-ANCA) antibodies, but she did have high levels of perinuclear (p-ANCA) antibodies. While c-ANCAs target proteinase 3 (PR3), p-ANCAs attach to myeloperoxidase (MPO). Both MPO and PR3 are proteins found in neutrophils.

The woman was diagnosed with p-ANCA-associated rapidly progressive glomerulonephritis and started on methylprednisolone, which commonly is used to reduce pain and inflammation.

She also developed a condition called uremic syndrome that’s characterized by inflammation and damage in the small blood vessels of the kidneys, further exams showed. She started receiving renal replacement therapy, a treatment that includes dialysis and hemodialysis.

A kidney biopsy confirmed the presence of kidney damage and the woman was treated with cyclophosphamide and mycophenolate mofetil, both immunosuppressants, and prednisone, a corticosteroid often used to reduce inflammation.

After treatment, her kidney function improved, as shown by a reduction in creatinine levels to 2.9 mg/dL. Three months later, no further hemodialysis was required and mycophenolate mofetil was given as a maintenance treatment.

Although the study didn’t show a direct association between the vaccine and the development of rapidly progressive glomerulonephritis, “it is possible to establish a temporal relationship and possibly identify the vaccine as a trigger for the development of autoimmune pathologies [diseases],” the researchers wrote.

The team noted that vaccination-related side effects should be monitored and considered in patients with a history of acute kidney function decline after vaccination.