Patients with immune-mediated
kidney diseases are at increased risk of severe
coronavirus disease 2019 (COVID-19). The international rollout of
COVID-19 vaccines has provided varying degrees of protection and enabled the understanding of
vaccine efficacy and safety. The immune response to
COVID-19 vaccines is lower in most patients with immune-mediated
kidney diseases; either related to immunosuppression or comorbidities and complications caused by the underlying disease. Humoral
vaccine response, measured by the presence of
antibodies, is impaired or absent in patients receiving
rituximab,
mycophenolate mofetil (MMF), higher doses of
glucocorticoids and likely other
immunosuppressants, such as
cyclophosphamide. The timing between the use of these agents and administration of
vaccines is associated with the level of immune response: with
rituximab,
vaccine response can only be expected once B cells start to recover and patients with transient discontinuation of MMF mount a humoral response more frequently. The emergence of new
COVID-19 variants and waning of
vaccine-induced immunity highlight the value of a booster dose and the need to develop mutant-proof
vaccines.
COVID-19 vaccines are safe, exhibiting a very low risk of de novo or relapsing immune-mediated
kidney disease. Population-based studies will determine whether this is causal or coincidental. Such cases respond to standard management, including the use of immunosuppression. The Immunonephrology Working Group and European
Vasculitis Society recommend that patients with immune-mediated
kidney diseases follow national guidance on vaccination. Booster doses based on antibody measurements could be considered.