A Case of Crescentic Glomerulonephritis after Receiving Messenger RNA Coronavirus Disease 2019 Vaccine and a Brief Review of Immunoglobulin A Nephropathy Postmessenger RNA Coronavirus Disease 2019 Vaccination

Abstract There have been several reports of newly diagnosed glomerulonephritis (GN) following messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccines in adult patients. Our patient is a previously healthy 31-year-old man who presented with generalized body swelling and hypertension 2 weeks after receiving the first dose of the Pfizer-BioNTech vaccine. A kidney biopsy was performed, and it revealed cellular crescents, mesangial hypercellularity and deposits. Given the presence of a first-degree relative with immunoglobulin A nephropathy (IgAN) in the family, kidney biopsy findings, normal complements, and negative antibody screening, patient was diagnosed with IgAN. Patient was treated with intravenous methylprednisolone 1 g for 3 days followed by oral prednisolone 60 mg daily with a slow taper. He also received a total of six 1 gm IV cyclophosphamide doses. The laboratory assessment at 1-year follow-up, revealed an improvement in serum creatinine from 210 to 128 µmol/L, a decrease in proteinuria from 6 to 1.2 g/day, and a complete resolution of microscopic hematuria. Although it is difficult to establish a causal relationship between mRNA COVID-19 vaccination and GN, we may recommend evaluating the risk/benefit ratio of COVID-19 vaccination (the second/third dose) in patients who’ve already developed new-onset or recurrent GN after the first/second dose.