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.

Centre for Inflammatory Disease Department of Immunology and Inflammation Imperial College London London UK

Department of Health Medicine and Caring Sciences Linköping University Linköping Sweden

Department of Medicine University of Cambridge Cambridge UK

Department of Nephrology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Nephrology and Renal Transplantation Patras University Hospital Patras Greece

Department of Nephrology Hospital Universitatio Fundacion Alcorcon Alcorcon Spain

Department of Nephrology Limassol General Hospital Limassol Cyprus

Department of Pediatrics Yonsei University College of Medicine Seoul South Korea

Department of Renal Medicine Karolinska University Hospital and CLINTEC Karolinska Institutet Stockholm Sweden

Division of Nephrology and Transplant Medicine Department of Medicine Leiden University Medical Center Leiden The Netherlands

Division of Nephrology Department of Clinical Sciences Lund Lund University and Skane University Hospital Lund Sweden

Division of Nephrology Department of Internal Medicine 4 Ludwig Maximilians University Hospital Munich Germany

Division of Nephrology Department of Internal Medicine Necmettin Erbakan University Konya Turkey

Division of Nephrology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA

Division of Nephrology RWTH Aachen University Hospital Aachen Germany

Glasgow Renal and Transplant Unit Queen Elizabeth University Hospital Glasgow UK

Imperial College Renal and Transplant Centre Imperial College Healthcare NHS Trust Hammersmith Hospital London UK

IZZ Immunologie Zentrum Zürich Zurich Switzerland

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