One patient with Sjogren's syndrome had acute deteriorated kidney function with worsened proteinuria accompanied by a marked increase anti-Ro antibody after the repeated AstraZeneca (AZ) COVID-19 vaccination (SCr 3.7 to 8.5 mg/dL, anti-Ro antibody 128 to >100,000 U/mL), she had received emergent HD shortly after the scheduled booster dose of mRNA COVID-19 vaccination despite strengthened immunosuppressants (Case 25, Figure 4C). The gene discussed is CALR; the disease is Sjogren syndrome.