The international deployment of mass vaccinations for coronavirus disease 2019 (COVID-19) has raised new concerns for caregivers who specialize in kidney disease. A number of reports question the ability of transplanted patients on maintenance immunosuppression and patients with kidney failure on dialysis to mount sufficient antibody responses to confer immunity against the virus. At the same time, nephrologists are faced with a small but growing literature of case reports linking COVID-19 vaccines with heightened off-target immune responses leading to the sudden development of de novo or relapsing glomerular diseases.