Minimal change disease following vaccination for SARS-CoV-2

Excerpt

A 39-year-old Caucasian male with a history of biopsy-proven minimal change disease with nephrotic syndrome, at one year of age, without recurrences after 6 months of steroid treatment, had been of regular follow-up for 37 years.  Three days after administration of the first dose of the BioNTech/Pfizer SARS-CoV-2 vaccine (BNT162b1^®) he  developed  weakness, fatigue, and lower limb edema. On the eighth day after vaccination, he was admitted to our Nephrology Unit with acute kidney injury (AKI) (serum creatinine 1.8 mg/dl vs baseline 0.9 mg/dl, creatinine clearance 44 ml/min) and full-blown nephrotic syndrome (proteinuria 8 g/24 h, unremarkable urine sediment, albuminemia 2.7 g/dl, total cholesterol 470 mg/dl, generalized peripheral edema). Diuresis was unaffected. Common causes of renal failure (nephrotoxic agents, dehydration, autoimmune and infectious diseases) were excluded. No infectious event or other relevant condition occurred in the weeks prior to the onset of nephrotic syndrome, except for the administration of the vaccine. Abdominal ultrasonography was unremarkable. A renal biopsy was diagnostic for minimal change disease (MCD) (Fig. 1). Oral prednisone (1 mg/kg for 4 weeks) was prescribed. The clinical picture rapidly improved with complete regression of proteinuria. Renal function was normal at the follow-up visit at the end of therapy. The steroid was discontinued after standard tapering. To date, the patient has not received the second dose of the vaccine. An interesting remark: he had been vaccinated against seasonal influenza (split inactivated vaccine) 6 months earlier without side effects.

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