Sex: M
Vaccine: COVID19
Symptoms: Microscopy, Urine protein/creatinine ratio abnormal
Clinical narrative: acute kidney injury; gross hematuria; This is a literature report in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine. This Other Health Professional reported similar events for two patients. This is the first of two reports.  To the editor: With great interest, we read the recent reports of IgA nephropathy (IgAN) flare-up presenting as macroscopic hematuria, following the second dose of coronavirus disease 2019 (COVID-19) vaccination in adult patients. The Food and Drug Administration granted an emergency use authorization for the Pfizer-BioNtech COVID-19 vaccination in Dec2020 for individuals aged $16 years; the emergency use authorization was recently expanded to include children aged 12 to 15 years on 10May2021. Herein, we report 2 pediatric patients with IgAN presenting with macroscopic hematuria <24 hours after Pfizer COVID-19 vaccination. Neither patient had COVID-19 infection before vaccination nor any history of reactions to any vaccinations. The first patient is a 13-year-old boy with a history of type 1 diabetes mellitus and known IgAN (IgAN with minor histomorphologic alterations on light microscopy. Representative glomerulus showing mild mesangial matrix expansion without mesangial hypercellularity on periodic acid-Schiff stain, original magnification x40. Immunofluorescence microscopy with 3+ granular mesangial reactivity for IgA, original magnification x10). His initial IgAN diagnosis was made 6 months before this event during an evaluation for subnephrotic proteinuria and microscopic hematuriawith normal renal function, and he was receiving treatment with lisinopril. Before COVID-19 vaccination: Microscopic hematuria and subnephrotic proteinuria noted on routine urine screening for diabetes, leading to IgAN diagnosis. Within 24 hours following the second dose of the COVID-19 vaccine, he developed new onset gross hematuria and acute kidney injury. His gross hematuria self-resolved, and his kidney function recovered without intervention within 1 week. Variables: Serum creatinine mg/dl, Before COVID-19 vaccination: 0.54; Following COVID-19 vaccination: Day 2: 1.31; Day 6: 0.66; Serum albumin, g/dl, Before COVID-19 vaccination was 3.4; Day 2: 3.8; Day 6: 3.0; Urine protein-tocreatinine ratio, mg/mg Before COVID-19 vaccination was 1.6; Day 2: 1.07; Day 6: 0.86. Oxford MEST-C score Before COVID-19 vaccination was M0 E0 S0 T0 C0. Stopped lisinopril on day 5.; Sender's Comments: Based on the review of available information, the causal relationship between the adverse reaction Acute Kidney Injury (AKI) and the suspect product  Pfizer-BioNtech COVID-19 vaccination is assessed as possibly related.  The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : 202101224443 Same article/ patient and different drug/event