Minimal change disease after COVID-19 vaccination

Kidney function can be impaired when there are problems with the glomeruli, the tiny units within the kidney where blood is cleaned. 

There have been a small but increasing number of cases of new-onset and relapse of glomerular diseases reported to have occurred in temporal association with the COVID-19 vaccines.

A new paper reports four such cases.

A 23-year-old woman with no significant past medical history presented with 5 days of generalized swelling and frothy urine 7 days after receiving her 2nd dose of the Moderna vaccine. She exhibited 3+ bilateral leg edema, mild periorbital edema, an elevated blood pressure of 150/80 mmHg, and a urine dipstick showing 4+ protein. Based on laboratory findings, the patient was diagnosed with Minimal change disease (MCD). The patient was started on a 1 mg/kg (70 mg) dose of oral prednisone together with a low dose of furosemide to help control her edema. Complete remission was achieved 4 weeks later. 

A 74-year-old Japanese man, had a medical history that was significant only for hypertension. He was admitted with a 4-week history of edema and a 7-kg increase in body weight. He had received the 2nd injection of the Pfizer/BioNTech vaccine 2 days before the onset of edema. Spontaneous remission from nephrotic syndrome was observed ~ 6 weeks after the onset of symptoms.

A 72-year-old woman with hypertension, obesity, and dyslipidemia who developed foamy urine and peripheral edema 14 days after receiving the 1st dose of the AstraZeneca/ChAdOx1-S vaccine. The patient was discharged 6 days after initiation of corticosteroid therapy.

A 71-year-old male with prior history of acute myeloid leukemia and subsequent allogeneic hematopoietic stem cell transplantation (HSCT) in 2015, glucocorticoid-induced diabetes, nephrotic syndrome, mild Graft versus host disease (GVHD) in the liver and other health conditions, received the 2nd dose of Moderna/NIAID on April 12, 2021. Within a week of getting the 2nd dose, the patient noted foamy and dark urine, periorbital and leg edema as well as abdominal bloating. He received rituximab 1 g infusion on May 6 and May 19, 2021, and a short course of high dose prednisone as well loop diuretics with improvement. He took the booster on December 12, 2021 and did not notice any change in the color of his urine or foamy urine. 

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REFERENCE

Chandra P, Roldao M, Drachenberg C, Santos P, Washida N, Clark A, Bista B, Mitsuna R, Yango A. Minimal change disease and COVID-19 vaccination: Four cases and review of literature. Clinical Nephrology. Case Studies. 2022;10:54.

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