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SARS-CoV-2 infection associated with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN): a systematic review and two case reports

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Abstract

Background

It has been observed that SARS-CoV-2 infections are associated with the development of various de-novo autoimmune diseases; little is known on new-onset antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) after SARS-CoV-2 infections.

Methods

We conducted a systematic review of previously reported cases with a presumed association of new-onset antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN). No language restrictions were applied during the search. The eligible articles included reports of biopsy-proven pauci-immune glomerulonephritis that occurred following SARS-CoV-2 infection. The review was registered in PROSPERO database (CRD42023407786). Two further cases are reported.

Results

The mean age of SARS-CoV-2 infection-associated ANCA-GN was 48 ± 19 years. Fifty-six percent of patients showed positivity for myeloperoxidase (MPO)-ANCA. Among tested patients, 36% had concomitantly positive antinuclear antibodies, and 100% had positive rheumatoid factor. Eleven out of the 21 cases (55%) were diagnosed with ANCA-GN during hospitalization due to SARS-CoV-2 infection. The remaining cases were diagnosed after a median of 2.1 months following COVID-19. Seventy-one percent of patients showed improvement in kidney function following different treatments. Case reports: one patient had positive p-ANCA and cryoglobulin. Another case had positive MPO-ANCA, c-ANCA, cryoglobulinemia, and rheumatoid factor.

Conclusion

SARS-CoV-2 infection-associated ANCA-GN patients are younger than primary ANCA-GN patients. The presence of atypical ANCA along with co-positivity with other autoantibodies can raise suspicion for SARS-CoV-2 infection-associated ANCA-GN.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Lancet (2023) The COVID-19 pandemic in 2023: far from over. Lancet 401:79. https://doi.org/10.1016/S0140-6736(23)00050-8

    Article  Google Scholar 

  2. Gambella A, Barreca A, Biancone L, Roccatello D, Peruzzi L, Besso L, Licata C, Attanasio A, Papotti M, Cassoni P (2022) Spectrum of kidney injury following COVID-19 disease: renal biopsy findings in a single italian pathology service. Biomolecules. https://doi.org/10.3390/biom12020298

    Article  PubMed  PubMed Central  Google Scholar 

  3. Izci Duran T, Turkmen E, Dilek M, Sayarlioglu H, Arik N (2021) ANCA-associated vasculitis after COVID-19. Rheumatol Int 41:1523–1529. https://doi.org/10.1007/s00296-021-04914-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jennette JC, Nachman PH (2017) ANCA glomerulonephritis and vasculitis. Clin J Am Soc Nephrol 12:1680–1691. https://doi.org/10.2215/CJN.02500317

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23:60–63. https://doi.org/10.1136/bmjebm-2017-110853

    Article  PubMed  PubMed Central  Google Scholar 

  6. Uppal NN, Kello N, Shah HH, Khanin Y, De Oleo IR, Epstein E, Sharma P, Larsen CP, Bijol V, Jhaveri KDD (2020) Novo ANCA-associated vasculitis with glomerulonephritis in COVID-19. Kidney Int Rep 5:2079–2083. https://doi.org/10.1016/j.ekir.2020.08.012

    Article  PubMed  PubMed Central  Google Scholar 

  7. Moeinzadeh F, Dezfouli M, Naimi A, Shahidi S, Moradi H (2020) Newly diagnosed glomerulonephritis during COVID-19 infection undergoing immunosuppression therapy, a case report. Iran J Kidney Dis 14:239–242

    PubMed  Google Scholar 

  8. Jalalzadeh M, Valencia-Manrique JC, Boma N, Chaudhari A, Chaudhari S (2021) Antineutrophil cytoplasmic antibody-associated glomerulonephritis in a case of scleroderma after recent diagnosis with COVID-19. Cureus 13:e12485. https://doi.org/10.7759/cureus.12485

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fireizen Y, Shahriary C, Imperial ME, Randhawa I, Nianiaris N, Ovunc B (2021) Pediatric P-ANCA vasculitis following COVID-19. Pediatr Pulmonol 56:3422–3424. https://doi.org/10.1002/ppul.25612

    Article  PubMed  PubMed Central  Google Scholar 

  10. Allena N, Patel J, Nader G, Patel M, Medvedovsky B (2021) A rare case of SARS-CoV-2-induced microscopic polyangiitis. Cureus 13:e15259. https://doi.org/10.7759/cureus.15259

    Article  PubMed  PubMed Central  Google Scholar 

  11. Selvaraj V, Moustafa A, Dapaah-Afriyie K, Birkenbach MP (2021) COVID-19-induced granulomatosis with polyangiitis. BMJ Case Rep. https://doi.org/10.1136/bcr-2021-242142

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wali HA, Tabb D, Baloch SA (2021) Diffuse alveolar hemorrhage associated with severe acute respiratory syndrome coronavirus 2. Cureus 13:e20171. https://doi.org/10.7759/cureus.20171

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zakrocka I, Korolczuk A, Zaluska W (2022) Antineutrophil cytoplasmic autoantibody-associated vasculitis with rapid progressive glomerulonephritis following SARS-CoV-2 infection: a cause or coincidence? Pol Arch Intern Med. https://doi.org/10.20452/pamw.16165

    Article  PubMed  Google Scholar 

  14. Powell WT, Campbell JA, Ross F, Pena-Jimenez P, Rudzinski ER, Dickerson JA (2021) Acute ANCA vasculitis and asymptomatic COVID-19. Pediatrics. https://doi.org/10.1542/peds.2020-033092

    Article  PubMed  Google Scholar 

  15. Martin Navarro JA, Cintra Cabrera M, Proccacini F, Munoz Rodriguez J, Roldan Cortes D, Lucena Valverde R, Ortega Diaz M, Puerta Carretero M, Gil Herrera J, Jaldo Rodriguez MT et al (2022) More difficult still: treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia. Nefrologia (Engl Ed) 42:94–98. https://doi.org/10.1016/j.nefroe.2020.12.007

    Article  PubMed  Google Scholar 

  16. Kataria S, Rogers S, Sadia H, Ali T, Qureshi HM, Bano S, Anigbo CL, Singh R (2022) Antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis after COVID-19 infection: a case report. Cureus 14:e26111. https://doi.org/10.7759/cureus.26111

    Article  PubMed  PubMed Central  Google Scholar 

  17. Madanchi N, Stingo FE, Patrick KC, Muthusamy S, Gupta N, Imran Fatani Y, Shah N (2021) Possible association between COVID-19 infection and de novo antineutrophil cytoplasmic antibody-associated vasculitis. Cureus 13:e20331. https://doi.org/10.7759/cureus.20331

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kawashima S, Kishimoto M, Hibino T, Lee H, Sato Y, Komagata Y, Kaname S (2022) MPO-ANCA-positive microscopic polyangiitis following COVID-19 infection. Intern Med 61:567–570. https://doi.org/10.2169/internalmedicine.8615-21

    Article  CAS  PubMed  Google Scholar 

  19. Maritati F, Moretti MI, Nastasi V, Mazzucchelli R, Morroni M, Bagnarelli P, Rupoli S, Tavio M, Galiotta P, Bisello W et al (2021) ANCA-associated glomerulonephritis and anti-phospholipid syndrome in a patient with SARS-CoV-2 infection: just a coincidence? Case Rep Nephrol Dial 11:214–220. https://doi.org/10.1159/000517513

    Article  PubMed  PubMed Central  Google Scholar 

  20. Alawad MJ, Subahi EA, Al-Ani HA, Taha NM, Kamal I (2022) A case of crescentic glomerulonephritis in a patient with COVID-19 infection: a case report and literature review. Medicine (Baltimore) 101:e28754. https://doi.org/10.1097/MD.0000000000028754

    Article  CAS  PubMed  Google Scholar 

  21. Bas D, Kucuk H (2021) A case report on simultaneous COVID-19 and rapidly progressive glomerulonephritis management in a patient with granulomatosis polyangiitis. Gazi Med J 32:585–588

    CAS  Google Scholar 

  22. Ta H, Awada H, Kang P, Gilbert N, Haller N, Mostow E, Lane J, Singh I (2022) Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis with mucosal involvement following COVID-19 pneumonia. Cureus 14:e31441. https://doi.org/10.7759/cureus.31441

    Article  PubMed  PubMed Central  Google Scholar 

  23. Asma H, Mariem BS, Nouha BM, Manel BS, Insaf H, Ahmed L, Mouna H, Sabra A, Habib S (2022) POS-930 ANCA associated vasculitis with crescentic glomerulonephritis complicating covid 19 in a 72-year-old man. Kidney Int Rep 7:S406. https://doi.org/10.1016/j.ekir.2022.01.970

    Article  Google Scholar 

  24. Kidney Disease: Improving Global Outcomes Glomerular Diseases Work, G. KDIGO (2021) Clinical practice guideline for the management of glomerular diseases. Kidney Int 2021(100):S1–S276. https://doi.org/10.1016/j.kint.2021.05.021

    Article  Google Scholar 

  25. Thammathiwat T, Banjongjit A, Iampenkhae K, Townamchai N, Kanjanabuch T (2023) ANCA associated glomerulonephritis following SARS-CoV-2 vaccination: a case series and systematic review. Vaccines (Basel). https://doi.org/10.3390/vaccines11050983

    Article  PubMed  Google Scholar 

  26. Nakazawa D, Masuda S, Tomaru U, Ishizu A (2019) Pathogenesis and therapeutic interventions for ANCA-associated vasculitis. Nat Rev Rheumatol 15:91–101. https://doi.org/10.1038/s41584-018-0145-y

    Article  CAS  PubMed  Google Scholar 

  27. Kitching AR, Anders HJ, Basu N, Brouwer E, Gordon J, Jayne DR, Kullman J, Lyons PA, Merkel PA, Savage COS et al (2020) ANCA-associated vasculitis. Nat Rev Dis Primers 6:71. https://doi.org/10.1038/s41572-020-0204-y

    Article  PubMed  Google Scholar 

  28. O’Sullivan KM, Holdsworth SR (2021) Neutrophil extracellular traps: a potential therapeutic target in MPO-ANCA associated vasculitis? Front Immunol 12:635188. https://doi.org/10.3389/fimmu.2021.635188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Aanaes K, Rasmussen N, Pressler T, Segelmark M, Johansen HK, Lindberg U, Hoiby N, Carlsson M, Wieslander J, Buchwald C (2012) Extensive endoscopic image-guided sinus surgery decreases BPI-ANCA in patients with cystic fibrosis. Scand J Immunol 76:573–579. https://doi.org/10.1111/j.1365-3083.2012.02775.x

    Article  CAS  PubMed  Google Scholar 

  30. Marino Gammazza A, Legare S, Lo Bosco G, Fucarino A, Angileri F, Conway de Macario E, Macario AJ, Cappello F (2020) Human molecular chaperones share with SARS-CoV-2 antigenic epitopes potentially capable of eliciting autoimmunity against endothelial cells: possible role of molecular mimicry in COVID-19. Cell Stress Chaperones 25:737–741. https://doi.org/10.1007/s12192-020-01148-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Shoenfeld Y, Agmon-Levin N (2011) “ASIA” - autoimmune/inflammatory syndrome induced by adjuvants. J Autoimmun 36:4–8. https://doi.org/10.1016/j.jaut.2010.07.003

    Article  CAS  PubMed  Google Scholar 

  32. Jara LJ, Vera-Lastra O, Mahroum N, Pineda C, Shoenfeld Y (2022) Autoimmune post-COVID vaccine syndromes: does the spectrum of autoimmune/inflammatory syndrome expand? Clin Rheumatol 41:1603–1609. https://doi.org/10.1007/s10067-022-06149-4

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fujinami RS, von Herrath MG, Christen U, Whitton JL (2006) Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease. Clin Microbiol Rev 19:80–94. https://doi.org/10.1128/CMR.19.1.80-94.2006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wraith DC, Goldman M, Lambert PH (2003) Vaccination and autoimmune disease: what is the evidence? Lancet 362:1659–1666. https://doi.org/10.1016/S0140-6736(03)14802-7

    Article  CAS  PubMed  Google Scholar 

  35. Vahabi M, Ghazanfari T, Sepehrnia S (2022) Molecular mimicry, hyperactive immune system, and SARS-COV-2 are three prerequisites of the autoimmune disease triangle following COVID-19 infection. Int Immunopharmacol 112:109183. https://doi.org/10.1016/j.intimp.2022.109183

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Carvelli J, Demaria O, Vely F, Batista L, Chouaki Benmansour N, Fares J, Carpentier S, Thibult ML, Morel A, Remark R et al (2020) Association of COVID-19 inflammation with activation of the C5a–C5aR1 axis. Nature 588:146–150. https://doi.org/10.1038/s41586-020-2600-6

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wang J, Jiang M, Chen X, Montaner LJ (2020) Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol 108:17–41. https://doi.org/10.1002/JLB.3COVR0520-272R

    Article  CAS  PubMed  Google Scholar 

  38. Stjepanovic MI, Stojanovic MR, Stankovic S, Cvejic J, Dimic-Janjic S, Popevic S, Buha I, Belic S, Djurdjevic N, Stjepanovic MM et al (2022) Autoimmune and immunoserological markers of COVID-19 pneumonia: can they help in the assessment of disease severity. Front Med (Lausanne) 9:934270. https://doi.org/10.3389/fmed.2022.934270

    Article  PubMed  Google Scholar 

  39. Zhu Y, Chen X, Liu X (2022) NETosis and neutrophil extracellular traps in COVID-19: immunothrombosis and beyond. Front Immunol 13:838011. https://doi.org/10.3389/fimmu.2022.838011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to acknowledge physicians, nurses, and technicians who are not listed as authors in this work and who take care of the patients in the King Chulalongkorn Memorial Hospital.

Funding

This study was supported by the Thailand Science Research and Innovation Fund Chulalongkorn University (CU_FRB65_hea (19)_026_30_07), Ratchadapiseksompotch Fund Chulalongkorn University (HEA663000115 and HEA663000116), and the Royal College of Physicians of Thailand (02/66).

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Authors and Affiliations

  1. Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand

    Athiphat Banjongjit

  2. Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

    Theerachai Thammathiwat

  3. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Natavudh Townamchai & Talerngsak Kanjanabuch

  4. Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Natavudh Townamchai

  5. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Talerngsak Kanjanabuch

  6. Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Talerngsak Kanjanabuch

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  1. Athiphat Banjongjit
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Correspondence to Talerngsak Kanjanabuch.

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Conflict of interest

TK has received consultancy fees from VISTERRA, ELEDON, Otsuka OLE, and Otsuka VISIONARY as country investigators and is a current recipient of the National Research Council of Thailand and received speaking honoraria from Astra Zeneca and Baxter Healthcare. The other authors declare that they have no relevant financial interests.

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Chulalongkorn University does not require ethical approval for reporting individual cases or case series, and systematic reviews.

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Banjongjit, A., Thammathiwat, T., Townamchai, N. et al. SARS-CoV-2 infection associated with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN): a systematic review and two case reports. J Nephrol 37, 53–63 (2024). https://doi.org/10.1007/s40620-023-01777-8

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