Acute COVID-19 Vaccine-Associated Glomerulonephritis: An Effect of Vaccination or the Infection Itself?

Dear Editor,

We read the article “Outcomes of COVID-19 Vaccine-Associated Glomerular Diseases (CVAGD) – A Case Series from India,”¹ attentively and complement the authors on their elegant compilation of CVAGD cases. We, however, have a few comments.

The authors identified only one patient with a prior COVID-19 infection. It is unclear if all patients were tested for SARS-CoV-2 using reverse transcriptase- polymerase chain reaction (RT-PCR) since a significant number of infected individuals may remain asymptomatic and acute infection-associated glomerulonephritis, with or without COVID-19 RNA positivity in kidney tissues is well-described.^2,3 This is especially relevant to patients described with relapses following COVID-19 vaccination. Viral infections are well-known triggers of relapses in patients with nephrotic syndrome.⁴

Data on the number of post-infections or infected patients with associated glomerulonephritis would clarify the CVAGD burden. Some studies have reported a reduction in the number of relapses in pediatric patients with nephrotic syndrome during the SARS-CoV-2 pandemic. No such literature is available for adults, and the etiopathogenesis differs from that of the pediatric age group.⁵