Relapse of minimal change disease following the third mRNA COVID-19 vaccination: a case report and literature review

Abstract

Mass vaccination is the most important strategy to terminate the coronavirus disease 2019 (COVID-19) pandemic. Reports suggest the potential risk of the development of new-onset or relapse of minimal change disease (MCD) following COVID-19 vaccination; however, details on vaccine-associated MCD remain unclear. A 43-year-old man with MCD, who had been in remission for 29 years, developed nephrotic syndrome 4 days after receiving the third dose of the Pfizer-BioNTech vaccine. His kidney biopsy revealed relapsing MCD. Intravenous methylprednisolone pulse therapy followed by oral prednisolone therapy was administered, and his proteinuria resolved within 3 weeks. This report highlights the importance of careful monitoring of proteinuria after COVID-19 vaccination in patients with MCD, even if the disease is stable and no adverse events occurred during previous vaccinations. Our case report and literature review of COVID-19 vaccine-associated MCD indicated that MCD relapse tends to occur later after vaccination and slightly more often following the second and subsequent vaccine doses than new-onset MCD.

Keywords: BNT162 vaccine; COVID-19 vaccine booster shot; Nephrotic syndrome; Recurrence; mRNA vaccines.

Fig. 1

Kidney biopsy findings. Light microscopy of representative glomerulus stained by a periodic acid–methenamine silver (original magnification, × 100) and b periodic acid–Schiff (original magnification, × 400), demonstrating minor glomerular abnormality. Hyalinosis of an arteriole is observed (arrow). c, d Electron microscopy reveals diffuse podocyte effacement without electron–dense deposits (original magnification, × 1500 and × 6000, respectively)