Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine

Abstract

We report on the development of minimal change disease (MCD) with nephrotic syndrome and acute kidney injury (AKI), shortly after first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). A 50-year-old previously healthy man was admitted to our hospital following the appearance of peripheral edema. Ten days earlier, he had received the first injection of the vaccine. Four days after injection, he developed lower leg edema, which rapidly progressed to anasarca. On admission, serum creatinine was 2.31 mg/dL and 24-hour urinary protein excretion was 6.9 grams. As kidney function continued to decline over the next days, empirical treatment was initiated with prednisone 80 mg/d. A kidney biopsy was performed and the findings were consistent with MCD. Ten days later, kidney function began to improve, gradually returning to normal. The clinical triad of MCD, nephrotic syndrome, and AKI has been previously described under a variety of circumstances, but not following the Pfizer-BioNTech COVID-19 vaccine. The association between the vaccination and MCD is at this time temporal and by exclusion, and by no means firmly established. We await further reports of similar cases to evaluate the true incidence of this possible vaccine side effect.

Keywords: Acute kidney injury (AKI); Acute tubular injury; Adverse effect; COVID-19 vaccine; Case report; Coronavirus 2019 (COVID-19); Kidney biopsy; Minimal change disease (MCD); Nephrotic syndrome (NS); Prednisone; Renal function; Side effect.

Figure 1

Timeline of clinical events from time of vaccination and until the kidney biopsy was performed.

Figure 2

Kidney biopsy findings. Light microscopy of representative glomerulus stained by (A) hematoxylin-eosin (original magnification, ×100) and (B) periodic acid–Schiff (original magnification, ×200), and of (C) the renal cortex stained by Masson trichrome (original magnification, ×40). (D) Electron microscopy of glomerulus (original magnification, ×1,200), demonstrating extensive effacement of foot processes and absence of electron-dense deposits.