Age: 46.0
Sex: M
Vaccine: COVID19, FLU4, PPV, TDAP
Symptoms: Anti-neutrophil cytoplasmic antibody positive vasculitis, Blood creatinine increased, Blood urine, Chromaturia, Erythema
Clinical narrative: On 10/12/23 patient had OV for right leg pain.  At that visit he had 4 vaccines?Tdap, COVID-19, influenza, and PCV23.  On 10/16/23 patient had OV with PCP.  At this OV he reported dark urine since 2 days prior.  Worsening localized redness with itching in right arm (where he had PCV23 and Tdap); no localized sxs in left arm (where he had COVID and influenza).  UA at this OV showed 3+ blood and was sent for microscopy. Clinical pharmacist consult done to research if there are hematuria risk associated with Tdap, COVID-19, influenza, or PCV23 vaccines.  Consult noted the following recommendation/assessment: ?UA abnormal showing 3+ blood. Updated labs show low H/H and elevated Scr compared to prior. Past labs showed LFTs were wnl.    No reports of hematuria after administration of Tdap, PCV23, or quadrivalent flu vaccines were identified.   The prevalence of urologic complications following administration of COVID-19 vaccines is low, but some studies reported renal side effects appear to be associated with COVID-19 vaccination. Case reports from VAERs data from 12/2020-08/2022 reported gross hematuria following COVID-19 vaccinations. A systematic review found a total of 130 cases reporting a renal adverse reaction following COVID-19 vaccination, of which 90 (69%) were new-onset kidney diseases, while 40 (31%) were relapsed kidney diseases. The most frequent renal side effects of COVID-19 vaccination were minimal change disease (52 cases), IgA nephropathy (48 cases), antineutrophil cytoplasmic autoantibody vasculitis (16 cases), and acute interstitial nephritis (12 cases). Other renal side effects occurred at a much lower frequency. Gross hematuria was one of the presenting characteristics in 90% of patients diagnosed with new or relapsing IgA nephropathy and 12.5% diagnosed with antineutrophil cytoplasmic autoantibody vasculitis.     No renal dose adjustments necessary for patient's current medications based on CrCl of 50 mL/min.? On 10/17/23 PCP spoke with patient on the phone about blood work showing decreased renal function and urine micro that confirms blood in urine.  Patient informed PCP that his urine was looking more clear and was of more normal volume.  Patient reported new mild shortness of breath without any associated cough, chest pain, or wheezing.  On 10/17/23 PCP placed urgent referral to nephrology.   On 10/18/23 patient had follow-up OV with PCP.  Patient reported that he was feeling better with respect to achiness, brain fog, fatigue.  Urine no longer dark.  Patient continues to have a vague sensation of feeling more short of breath without any chest pain, cough or wheezing.  Localized redness in right arm has resolved.   After OV on 10/18/23 PCP spoke with nephrologist who recommended repeat blood work which was ordered.  If creatinine still abnormal nephrologist also recommended getting a renal US.  If creatinine worsening nephrologist asked PCP to call back and they would get him a nephrology appt as soon as possible. On 10/20/23 PCP called patient to review lab results.  Kidney function trending toward normal.  Patient no longer seeing blood in urine and generally feeling better except for lingering fatigue.  Given that renal function still not normal PCP ordered a renal US (which is scheduled for 11/9/23).