Post-vaccinal minimal change disease
Authors: Jari Weijers, Carmen Alvarez, Marc M.H. Hermans
Journal: Kidney International (2021)

Previous reports have described the onset of minimal change disease after the administration of certain vaccines.1Gutierrez 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 Recently a 61-year-old woman was admitted to our hospital 8 days after her first coronavirus disease 2019 (COVID-19) vaccination (BioNTech/Pfizer SARS-CoV-2 COMIRNATY) because of edema and weight gain (6 kg). Medical history included autoimmune hepatitis and hypothyroidism, for which she used tioguanine (20 mg), prednisone (2.5 mg), and levothyroxine (50 μg). Her kidney function and urine sediment had always been normal. Symptoms, consisting of edema in the lower extremities, dyspnea, and oliguria, started 1 day after vaccination. Physical examination revealed edema in the lower extremities without further abnormalities. Laboratory findings showed hypoalbuminemia (21 g/l), an elevated creatinine level (1.47 mg/dl), and nephrotic range proteinuria (12 g/l; Figure 1). Urine analysis showed no glomerular erythrocyturia. Diagnostic workup, consisting of anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, anti-PLA2R, protein spectrum, free light chains, C3/C4 levels, hepatitis B surface antigen, and hepatitis C virus, was negative. A diagnostic kidney biopsy was performed. Serum creatinine rose to 3.6 mg/dl, and renal replacement therapy was started because of anuria and diuretic resistant fluid overload with pleural effusion and dyspnea. Steroids (1 mg/kg) were administrated, pending biopsy results. Light microscopy did not show significant glomerular nor tubular abnormalities, immunofluorescence was negative, and electron microscopy showed extensive foot process effacement (Figure 2), most of which are compatible with minimal change disease. Kidney function gradually recovered with decreasing proteinuria (2.3 g/l). After 3 weeks, hemodialysis could be stopped.Figure 2Kidney biopsy findings. (a) Light microscopy with Jones stain shows no glomerular or tubular abnormalities. Original magnification ×400. (b) Electron microscopy. Red arrow indicates extensive podocyte foot process effacement. Original magnification ×6000. Bar = 10 μm. To optimize viewing of this image, please see the online version of this article at www.kidney-international.org.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This case adds to other reports of new-onset nephrotic syndrome after COVID-19 vaccination.2D'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,3Lebedev 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 If new-onset nephrotic syndrome incidence rises after this type of vaccination, reporting nephrotic syndrome as a side effect in patient information should be considered. 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