Minimal change disease following the Moderna mRNA-1273 SARS-CoV-2 vaccine
Authors: Amy Holzworth, Patrick Couchot, Wanda Cruz-Knight, Michael Brucculeri
Journal: Kidney International (2021)

The immunologic response following several varieties of vaccination has been described as a potential trigger for the development of both de novo as well as recurrent minimal change disease (MCD).1Gutiérrez S. Dotto B. Petiti J.P. et al.Minimal change disease following influenza vaccination and acute renal failure: just a coincidence?.Nefrologia. 2012; 32: 414-415PubMed Google Scholar There have been emerging cases, including that described by D'Agati et al., of MCD shortly after vaccination with the BNT162b2 vaccine (Pfizer-BioNTech).2Lebedev L. Sapojnikov M. Wechsler A. et al.Minimal change disease following the Pfizer-BioNTech COVID-19 vaccine.Am J Kidney Dis. 2021; 78: 142-145Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar,3D'Agati V.D. Kudose S. Bomback A.S. et al.Minimal change disease and acute kidney injury following the Pfizer-BioNTech COVID-19 vaccine.Kidney Int. 2021; 100: 461-463Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar We report, to the best of the authors' knowledge, the first case of MCD presenting as nephrotic syndrome following the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The patient, a 63-year-old woman, had a medical history that was significant only for hypertension and tobacco dependence. She had no prior history of renal disease. In April 2021, she presented to our hospital with a 4-week history of progressive anasarca, fatigue, periorbital edema, and dyspnea. The patient relayed that the edema and development of foamy urine appeared abruptly and occurred less than a week after having received the first (and only) dose of the Moderna mRNA-1273 SARS-CoV-2 vaccine (lot 006B21A). Vaccination was confirmed by cross-referencing her outpatient pharmacy, which administered the dose. Unfortunately, anti-S protein antibody titer is not available to report. Clinical and diagnostic evaluation also revealed newly uncontrolled hypertension (181/82 mm Hg) as well as mild acute kidney injury (serum creatinine 1.48 mg/dl; baseline was 0.7 mg/dl). Hypoalbuminemia (0.7 g/dl), urinalysis with 3+ proteinuria (without microscopic hematuria), and hyperlipidemia (triglycerides, 221 mg/dl; total cholesterol, 450 mg/dl) were noted. Nephrotic syndrome was confirmed as the 24-hour urine collection revealed 13.4 g proteinuria. Renal biopsy was promptly performed. Pathology confirmed MCD, with mild acute tubular injury, although a focal acute interstitial nephritis was also present. Four of 69 sampled glomeruli were globally sclerosed. There was 10% tubulointerstitial fibrosis. The sampled glomeruli were found to have 100% foot process effacement (Figure 1). Treatment with conservative measures, including valsartan, 80 mg orally twice a day, for renin-angiotensin-aldosterone system inhibition was initiated along with a loop diuretic. She was also given pulse methyl-prednisolone, 500 mg i.v. for 3 days, followed by 1 mg/kg prednisone orally. On the basis of other case reports and our experience with MCD, we anticipate a prompt response to these measures.4Vivarelli M. Massella L. Ruggiero B. et al.Minimal change disease.Clin J Am Soc Nephrol. 2017; 12: 332-345Crossref PubMed Scopus (326) Google Scholar We have recommended the patient forgo the second scheduled dose of the Moderna mRNA-1273 SARS-CoV-2 vaccine. In addition, the authors believe further rechallenges or boosters of this particular vaccine in this patient would be unwise until this potential relationship is more clear. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor-in-chief of this journal. Author contributions were evenly divided, and included but not limited to patient care, research, writing the article, and subsequent revisions. Minimal change disease and acute kidney injury following the Pfizer-BioNTech COVID-19 vaccineKidney InternationalVol. 100Issue 2PreviewAs mass vaccinations for coronavirus disease 2019 (COVID-19) are being administered worldwide, rare reports of adverse events are emerging. We report a case of minimal change disease presenting with nephrotic syndrome 1 week after a first injection of the COVID-19 vaccine (Pfizer-BioNTech). Full-Text PDF COVID-19 vaccination followed by activation of glomerular diseases: does association equal causation?Kidney InternationalVol. 100Issue 5PreviewTo date, >4 billion doses of the various severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been administered worldwide in response to the coronavirus disease 2019 (COVID-19) pandemic. Even as widespread vaccination campaigns have contributed to declining case rates, adverse events are appearing beyond those originally reported in the clinical trials of vaccine efficacy and safety. Of particular relevance to the kidney is the increasing number of reports of de novo or reactivation of glomerular diseases (Table 11–25). Full-Text PDF