To, The Editor,

Kidney International Reports

Sir,

There have been multiple reports of nephrotic syndrome following the Pfize-BioNTech COVID-19 vaccine.1-3 We report a similar case of nephrotic syndrome which developed shortly after receiving ChAdOx1 nCoV-19 vaccine against SARS CoV -2 developed by Oxford University and AstraZeneca (Covishield , Serum Institute of India, Pune, India). It is a viral vector vaccine developed using the modified chimpanzee adenovirus ChAdOx1 as a vector.

A 19- year old girl, presented with generalised body swelling, which started eight days after the first dose of the Covishield COVID vaccine. Clinical examination was unremarkable except for generalised edema. Blood tests revealed serum creatinine, 1.09 mg/dL; albumin, 2.15 g/dL; and total cholesterol, 274 mg/dL. Urine protein creatinine ratio of 3.18 g/g. Additional evaluation for secondary causes was negative. Kidney biopsy revealed eleven glomeruli with normal capillary walls with diffuse and global mesangial cell proliferation on light microscopy (Figure 1). The glomerular walls did not stain for immunoglobulins or complement, but there was mesangial trapping of IgM(1+) and C3(1+). A diagnosis of a mesangial proliferative variant of minimal change disease was made. She responded to oral prednisone 1 mg/ kg body weight with clinical and biochemical remission.

FigureGlomerulus revealing mild to moderate increase in the mesangial cellularity globally (HE, 40x)

To the best of our knowledge, this is a first ever report of nephrotic syndrome after the ChAdOx1 nCoV-19 vaccine. The temporal profile of nephrotic syndrome after the COVID-19 vaccination and absence of any other precipitating factors points toward the vaccine as a possible trigger. It is uncertain if she should be advised to take the second dose and when it can be safely taken.

Uncited reference1

Lebedev L, Sapojnikov M, Wechsler A, Varadi-Levi R, Zamir D, Tobar A, et al. Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis. 2021 Apr 8:S0272-6386(21)00509-6. doi: 10.1053/j.ajkd.2021.03.010.

, 2

D’Agati VD , Kudose S , Bomback AS , Adamidis A and Tartini A . Minimal Change Disease and Acute Kidney Injury Following the Pfize-BioNTech COVID-19 vaccine Kidney International. Published ahead of print 14, May 20212 .https://doi.org/10.1016/j.kint.2021.04.035

, 3

Maas RJ , Gianotten S, van der Meijden WAG. An Additional Case of Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis Published online May 12, 2021 https://doi.org/10.1053/j.ajkd.2021.05.003

.References:

Lebedev L, Sapojnikov M, Wechsler A, Varadi-Levi R, Zamir D, Tobar A, et al. Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis. 2021 Apr 8:S0272-6386(21)00509-6. doi: 10.1053/j.ajkd.2021.03.010.

D’Agati VD , Kudose S , Bomback AS , Adamidis A and Tartini A . Minimal Change Disease and Acute Kidney Injury Following the Pfize-BioNTech COVID-19 vaccine Kidney International. Published ahead of print 14, May 20212 .https://doi.org/10.1016/j.kint.2021.04.035

Maas RJ , Gianotten S, van der Meijden WAG. An Additional Case of Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis Published online May 12, 2021 https://doi.org/10.1053/j.ajkd.2021.05.003

Article InfoPublication History

Accepted: June 21, 2021

Received: June 17, 2021

Publication stageIn Press Journal Pre-ProofFootnotes

Source of funding: Nil

Conflict of interest : Nil

Identification

DOI: https://doi.org/10.1016/j.ekir.2021.06.024

Copyright

© 2021 Published by Elsevier Inc. on behalf of the International Society of Nephrology.

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