IgA nephropathy with glomerular capillary IgA deposition following SARS-CoV-2 mRNA vaccination: a report of three cases

IgA nephropathy (IgAN) cases histopathologically showing glomerular capillary IgA deposition represent a rare subtype of primary IgAN. Patients with IgAN categorized to this subtype often exhibit heavy proteinuria, advanced histological findings, and are resistant to therapies. Here, we report three cases of biopsy-proven IgAN with glomerular capillary IgA deposition who presented acute deterioration of urinalysis findings following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccinations. Case 1 was recurrent IgAN. Case 2 and Case 3 were newly diagnosed cases with subclinical microhematuria and proteinuria history. All three cases showed gross hematuria and acute exacerbations of proteinuria following SARS-CoV-2 mRNA vaccinations. In all three cases, kidney biopsy findings showed IgA deposition in glomerular capillary walls in addition to mesangial and para-mesangial areas; acute glomerular lesions, such as intra- and extracapillary proliferations were identified, indicating the possibility of a potentially severe type of IgAN. Therefore, attention should be paid to patients with de novo or relapsing IgAN showing marked capillary IgA deposition following SARS-CoV-2 vaccination.

Automated summary

This study reported three cases of IgA nephropathy with glomerular capillary IgA deposition, which showed acute deterioration of urinalysis findings following SARS-CoV-2 mRNA vaccinations. Kidney biopsy showed severe glomerular lesions, indicating a potentially severe type of IgAN. Therefore, patients with de novo or relapsing IgAN showing significant capillary IgA deposition following SARS-CoV-2 vaccination should be monitored closely.