ESPN 54th Annual Meeting

ESPN 2022


 
Childhood nephrotic syndrome and acute kidney injury following the SARS-CoV-2 BNT162b2 vaccine
PONDTIP JONGVILAIKASEM 1 NUANPAN SIRIPEN 2 YONG POOVORAWAN 3 PORNPIMOL RIANTHAVORN 2

1- PEDIATRIC DIVISION, HAT YAI MEDICAL EDUCATION CENTER, HAT YAI HOSPITAL, SONGKHLA, THAILAND
2- DIVISION OF NEPHROLOGY, DEPARTMENT OF PEDIATRICS, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY
3- CENTER OF EXCELLENCE IN CLINICAL VIROLOGY, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY
 
Introduction:

Widespread vaccination is a critical tool to protect everyone from coronavirus disease 2019.  The SARS-CoV-2 BNT162b2 vaccine (COMIRNATY, Pfizer-BioNTech) has received emergency authorization for children aged five years and above. Although results from the vaccine safety monitoring are reassuring, it is important to continue to monitor the safety of the vaccine.

Material and methods:

 The clinical course of a male adolescent who developed minimal change disease (MCD) and acute kidney injury (AKI) after first injection of COMIRNATY was retrospectively reviewed.

Results:

A previously healthy 14-year-old boy developed anasarca five days after the first vaccination. Clinical evaluation revealed hypertension, nephrotic syndrome (proteinuria 4+ and 9 g/g creatinine of spot urine, albumin 2 g/dl and cholesterol 257 mg/dl), and AKI (creatinine 2 mg/dl). Diagnostic workup, including C3/C4, ANA, ANCA, hepatitis B surface antigen, and antibodies to hepatitis C virus, were negative. Ten days after vaccination, he became anuric with peak creatinine of 9 mg/dl. Three doses of daily pulse methylprednisolone followed by 60 mg of daily oral prednisolone were administered. He received acute hemodialysis for three weeks (Figure 1a). Kidney biopsy showed unremarkable glomeruli, diffuse tubular epithelial injury, interstitial inflammatory cell infiltration, and negative immunofluorescence staining. Electron microscopy showed diffuse foot process effacement (Figure 1b-d). After the 5-week treatment with corticosteroids, the patient was in partial remission (creatinine 0.53 mg/dl and proteinuria 0.9 g/g creatinine). Total immunoglobulins specific to the receptor-binding domain of the SARS-CoV-2 spike protein using Elecsys® (Roche Diagnostics,  Basel, Switzerland) was 5.6 U/ml (positive ≥0.8 U/ml).

 

Conclusions:

The temporal association with vaccination in the patient suggests that a T-cell mediated immune response to viral mRNA could induce podocytopathy.  The incidence of MCD following COMIRNATY injection needs to be determined. Including nephrotic syndrome into pediatric safety concerns should be considered to raise clinician and parental awareness of this potential adverse effect.