The onset of various
kidney diseases has been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. However, detailed clinical and pathological features are lacking. We screened and analyzed patients with newly diagnosed
kidney diseases after inactivated SARS-CoV-2 vaccination in Peking University First Hospital from January 2021 to August 2021, and compared them with the reported cases in the literature. We obtained samples of blood, urine and renal biopsy tissues. Clinical and laboratory information, as well as light microscopy, immunostaining and ultrastructural observations, were described. The
SARS-CoV-2 spike protein and
nucleoprotein were stained using the immunofluorescence technique in the kidney biopsy samples. SARS-CoV-2 specific
antibodies were tested using magnetic particle chemiluminescence immunoassay. The study group included 17 patients with a range of conditions including
immune-complex-mediated
kidney diseases (
IgA nephropathy,
membranous nephropathy and
lupus nephritis), podocytopathy (
minimal change disease and
focal segmental glomerulosclerosis) and others (
antineutrophil-cytoplasmic-antibody-associated
vasculitis, anti-glomerular basement membrane
nephritis,
acute tubulointerstitial nephritis and
thrombotic microangiopathy). Seven patients (41.18%) developed renal disease after the first dose and ten (58.82%) after the second dose. The
kidney disease spectrum as well as clinicopathological features are similar across different types of
SARS-CoV-2 vaccines. We found no definitive evidence of
SARS-CoV-2 spike protein or
nucleoprotein deposition in the kidney biopsy samples. Seropositive markers implicated abnormal immune responses in predisposed individuals. Treatment and follow-up (median = 86 days) showed that biopsy diagnosis informed treatment and prognosis in all patients. In conclusion, we observed various
kidney diseases following
SARS-CoV-2 vaccine administration, which show a high consistency across different types of
SARS-CoV-2 vaccines. Our findings provide evidence against direct
vaccine protein deposition as the major pathomechanism, but implicate abnormal immune responses in predisposed individuals. These findings expand our understanding of
SARS-CoV-2 vaccine renal safety.