Adult-onset nephrotic syndrome following COVID-19 vaccination

Abstract A 22-year-old healthy man was admitted for edema 15 days after the first injection of the COVISHIELD COVID-19 vaccine (Oxford AstraZeneca) vaccine. Nephrotic syndrome was diagnosed and a kidney biopsy showed minimal change disease. Oral Prednisolone was started at 1mg/kg/day resulting in complete remission within one week.

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Minimal change disease soon after Pfizer-BioNTech COVID-19 vaccination

Clinical Kidney Journal ◽

10.1093/ckj/sfab156 ◽

2021 ◽

Author(s):

Seiji Kobayashi ◽

Kazunori Fugo ◽

Kazuto Yamazaki ◽

Hiroyuki Terawaki

Keyword(s):

Adverse Effect ◽

Nephrotic Syndrome ◽

Complete Remission ◽

Messenger Rna ◽

Minimal Change Disease ◽

Kidney Biopsy ◽

Minimal Change ◽

Healthy Male ◽

Intravenous Methylprednisolone ◽

True Incidence

Abstract We report on the onset of minimal change disease (MCD) presenting with anasarca after a second dose of the messenger RNA (mRNA)-based Pfizer-BioNTech vaccine against coronavirus disease 2019 (COVID-19). A 75-year-old previously healthy male was admitted with rapidly progressive anasarca and proteinuria of 7.7 g/day following the second dose. A kidney biopsy revealed MCD with nephrotic syndrome. He was treated with intravenous methylprednisolone followed by prednisolone, leading to complete remission after 35 days in the hospital. Since definite causality between the vaccine and MCD remains unclear, awareness of this potential adverse effect of mRNA vaccines is important to determine its true incidence and frequency.

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De Novo Minimal Change Disease following Vaccination with the Pfizer/BioNTech SARS-CoV-2 Vaccine in a Living Kidney Donor

Medicina ◽

10.3390/medicina58010037 ◽

2021 ◽

Vol 58 (1) ◽

pp. 37

Author(s):

Smaragdi Marinaki ◽

Kyriaki Kolovou ◽

George Liapis ◽

Chrysanthi Skalioti ◽

Stathis Tsiakas ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Complete Remission ◽

Minimal Change Disease ◽

De Novo ◽

Vaccine Dose ◽

Oral Prednisolone ◽

Minimal Change ◽

Kidney Donor ◽

Living Kidney Donor ◽

Glomerular Diseases

Coronavirus disease 2019 has developed as a pandemic. Immunization with the introduction of vaccines against COVID-19 seems be the only way to end this pandemic. We report on a case of a kidney donor, who developed minimal change disease (MCD) within 4 days post-vaccination with the SARS-CoV-2 BNT162b2 mRNA vaccine (Pfizer/BioNTech). She donated her kidney to her husband 4 years ago. After receiving the 1st vaccine dose, she presented with nephrotic syndrome, with complete remission 5 days later. She proceeded with the second dose of the BNT162b2 vaccine at the appointed time. Two days later, she presented with a relapse of full-blown nephrotic syndrome with preserved renal function. We performed an ultrasound-guided percutaneous kidney biopsy and the final diagnosis was consistent with minimal change disease. Oral prednisolone was promptly initiated at a dosage of 1 mg/kg daily and complete remission was achieved 10 days later. More data about this rare appearance of de novo glomerular diseases after SARS-CoV-2 vaccination are emerging and should be interpreted rigorously.

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Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

Journal of Clinical Medicine ◽

10.3390/jcm10163632 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3632

Author(s):

Sophia Lionaki ◽

Evangelos Mantios ◽

Ioanna Tsoumbou ◽

Smaragdi Marinaki ◽

George Makris ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Injury ◽

Spontaneous Remission ◽

Minimal Change ◽

Adult Onset ◽

Potential Risk Factors ◽

The Mean ◽

End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

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Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings

Case Reports in Nephrology and Dialysis ◽

10.1159/000507426 ◽

2020 ◽

Vol 10 (1) ◽

pp. 42-50 ◽

Cited By ~ 2

Author(s):

Yuko Oyama ◽

Yoichi Iwafuchi ◽

Tetsuo Morioka ◽

Ichiei Narita

Keyword(s):

Elderly Patient ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Biopsy ◽

Fluid Management ◽

Kidney Injury ◽

Oral Prednisolone ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Fluid Removal

Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.

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The Transition From Minimal Change Disease to Focal and Segmental Glomerulosclerosis in a Patient With Nephrotic Syndrome: a Case Report

10.21203/rs.3.rs-153788/v1 ◽

2021 ◽

Author(s):

Long Tang ◽

Zhen Cai ◽

Yuan Meng ◽

Wen-jing Zhao ◽

Su-Xia Wang

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Biopsy ◽

Elevated Serum ◽

Minimal Change ◽

Segmental Glomerulosclerosis ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship

Abstract Background:Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome(NS), they are not completely independent. We report a patient presenting a transition from MCD to FSGS, review the literature and explore the relationship between the two diseases.Case presentation:A 42-year-old male welder, Asian, presenting lower extremity edema and elevated serum creatinine, had laboratory exams indicating NS and end-stage renal disease(ESRD). The patient had a kidney biopsy 20 years earlier for NS, which indicated MCD, and this repeated kidney biopsy suggested FSGS. After treatment follow-up, the patient was eventually admitted to renal replacement therapy. Conclusions:MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates the progression of the disease, which may be related to the excessive metal caused by occupation.

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Rituximab as a front-line therapy for adult-onset minimal change disease with nephrotic syndrome

Oncotarget ◽

10.18632/oncotarget.25612 ◽

2018 ◽

Vol 9 (48) ◽

pp. 28799-28804 ◽

Cited By ~ 5

Author(s):

Roberta Fenoglio ◽

Savino Sciascia ◽

Giulietta Beltrame ◽

Paola Mesiano ◽

Michela Ferro ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Minimal Change ◽

Adult Onset ◽

Front Line ◽

Line Therapy

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Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06180519 ◽

2020 ◽

Vol 15 (2) ◽

pp. 209-218 ◽

Cited By ~ 9

Author(s):

Nicholas Rhys Medjeral-Thomas ◽

Christopher Lawrence ◽

Marie Condon ◽

Bhrigu Sood ◽

Paul Warwicker ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Nephrotic Syndrome ◽

Complete Remission ◽

Minimal Change Disease ◽

De Novo ◽

Controlled Trial ◽

Minimal Change ◽

Randomized Controlled ◽

Remission Rates ◽

Relapse Rates

Background and objectivesMinimal change disease is an important cause of nephrotic syndrome in adults. Corticosteroids are first-line therapy for minimal change disease, but a prolonged course of treatment is often required and relapse rates are high. Patients with minimal change disease are therefore often exposed to high cumulative corticosteroid doses and are at risk of associated adverse effects. This study investigated whether tacrolimus monotherapy without corticosteroids would be effective for the treatment of de novo minimal change disease.Design, setting, participants, & measurementsThis was a multicenter, prospective, open-label, randomized, controlled trial involving six nephrology units across the United Kingdom. Adult patients with first presentation of minimal change disease and nephrotic syndrome were randomized to treatment with either oral tacrolimus at 0.05 mg/kg twice daily, or prednisolone at 1 mg/kg daily up to 60 mg daily. The primary outcome was complete remission of nephrotic syndrome after 8 weeks of therapy. Secondary outcomes included remission of nephrotic syndrome at 16 and 26 weeks, rates of relapse of nephrotic syndrome, and changes from baseline kidney function.ResultsThere were no significant differences between the tacrolimus and prednisolone treatment cohorts in the proportion of patients in complete remission at 8 weeks (21 out of 25 [84%] for prednisolone and 17 out of 25 [68%] for tacrolimus cohorts; P=0.32; difference in remission rates was 16%; 95% confidence interval [95% CI], −11% to 40%), 16 weeks (23 out of 25 [92%] for prednisolone and 19 out of 25 [76%] for tacrolimus cohorts; P=0.25; difference in remission rates was 16%; 95% CI, −8% to 38%), or 26 weeks (23 out of 25 [92%] for prednisolone and 22 out of 25 [88%] for tacrolimus cohorts; P=0.99; difference in remission rates was 4%; 95% CI, −17% to 25%). There was no significant difference in relapse rates (17 out of 23 [74%] for prednisolone and 16 out of 22 [73%] for tacrolimus cohorts) for patients in each group who achieved complete remission (P=0.99) or in the time from complete remission to relapse.ConclusionsTacrolimus monotherapy can be effective alternative treatment for patients wishing to avoid steroid therapy for minimal change disease.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_01_16_CJN06180519.mp3

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Renal Pathology in Adult Onset Idiopathic Nephrotic Syndrome A Study of 100 Cases

TAJ Journal of Teachers Association ◽

10.3329/taj.v20i2.3076 ◽

1970 ◽

Vol 20 (2) ◽

pp. 140-143

Author(s):

M Hasan Tarik ◽

ARMS Ekram ◽

Md Azizul Haque ◽

AKM Monoarul Islam ◽

M Jalal Uddin

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Membranoproliferative Glomerulonephritis ◽

Minimal Change Disease ◽

Idiopathic Nephrotic Syndrome ◽

Minimal Change ◽

Adult Onset ◽

College Hospital ◽

Medical College ◽

Membranous Gn

This study was carried out in the nephrology unit to Rajshahi Medical College Hospital, Rajshahi during the period 2003-2005. Renal biopsy was done in one hundred adult patients with Nephrotic syndrome to evaluate the histopathological pattern. Mesangioproliferative GN was the commonest underlying cause which is found in 36 (40%) cases. MPGN is followed by minimal change disease in 22 (24.44%), membranous GN 16 (17.77%), membranoproliferative glomerulonephritis 12 (13.33%), Focal segmental glomerulosclerosis 3 (3.34%) and IgA nephropathy 1 (1.12%) cases. This is concordant with other studies. doi: 10.3329/taj.v20i2.3076 TAJ 2007; 20(2): 140-143

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Rituximab Induces Complete Remission of Proteinuria in a Patient With Minimal Change Disease and No Detectable B Cells

Frontiers in Immunology ◽

10.3389/fimmu.2020.586012 ◽

2021 ◽

Vol 11 ◽

Author(s):

Maximilian Webendörfer ◽

Linda Reinhard ◽

Rolf A. K. Stahl ◽

Thorsten Wiech ◽

Hans-Willi Mittrücker ◽

...

Keyword(s):

T Cells ◽

Nephrotic Syndrome ◽

B Cells ◽

Complete Remission ◽

Treatment Efficacy ◽

Minimal Change Disease ◽

Predictive Biomarkers ◽

Minimal Change ◽

Frequent Relapses ◽

Steroid Sensitive Nephrotic Syndrome

Minimal change disease (MCD) is a common cause of nephrotic syndrome. Treatment with steroids is usually effective, but frequent relapses are therapeutic challenges. The anti-CD20 antibody rituximab has shown promising results for treatment of steroid-sensitive nephrotic syndrome. Since predictive biomarkers for treatment efficacy and the accurate rituximab dosage for effective induction of remission are unknown, measurement of CD19+ B cells in blood is often used as marker of successful B cell depletion and treatment efficacy. A male patient with relapsing MCD was successfully treated with rituximab, but developed relapse of proteinuria 1 year later, although no B cells were detectable in his blood. B and T cell populations in the patient’s blood were analyzed before and after treatment with rituximab using FACS analysis. Rituximab binding to B and T cells were measured using Alexa Fluor 647 conjugated rituximab. We identified a population of CD20+ CD19− cells in the patient’s blood, which consisted mostly of CD20+ CD3+ T cells. Despite the absence of B cells in the blood, the patient was again treated with rituximab. He developed complete remission of proteinuria and depletion of CD20+ T cells. In a control patient with relapsing MCD initial treatment with rituximab led to depletion of both CD20+ B and T cells. Rituximab induces remission of proteinuria in patients with MCD even if circulating B cells are absent. CD20+ T cells may play a role in the pathogenesis of MCD and might be a promising treatment target in patients with MCD.

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Minimal Change Disease After First Dose of Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Review of Minimal Change Disease Related to COVID-19 Vaccine

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211058271 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110582

Author(s):

Jessica Hanna ◽

Alistair Ingram ◽

Tiffany Shao

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Biopsy ◽

De Novo ◽

Rare Complication ◽

Minimal Change ◽

Steady Increase ◽

Rapid Weight Loss ◽

Tubular Injury ◽

Number Of Patients

Rationale: While severe complications are generally uncommon with novel coronavirus disease 2019 (COVID-19) vaccine, there has been a steady increase in the number of patients presenting with nephrotic syndrome and acute kidney injury after the administration of COVID-19 vaccine. Physicians should be made aware of minimal change disease as a potential complication associated with COVID-19 vaccine. Presenting concerns: A 60-year-old male without significant past medical history presented with new onset of nephrotic syndrome approximately 10 days after his first dose of Pfizer-BioNTech COVID-19 vaccine. Laboratory findings showed hypoalbuminemia (20 g/L), elevated urine albumin/creatinine ratio (668 mg/mmol), and elevated creatinine of 116 µmol/L from a baseline of 79 µmol/L. Diagnosis: A diagnostic kidney biopsy was performed 6 weeks after the onset of the edema and approximately 8 weeks after his first dose of Pfizer-BioNTech COVID-19 vaccine. The kidney biopsy findings were consistent with minimal change disease with focal acute tubular injury. Interventions: The patient was treated conservatively with ramipril 10 mg and furosemide 80 mg daily 5 weeks after the onset of swelling. Prednisone 1 mg/kg was initiated immediately when the kidney biopsy result became available (approximately 6 weeks after the onset of edema). Outcomes: The patient remitted with rapid weight loss starting 2 weeks post prednisone initiation. Novel findings: De novo minimal change disease with acute tubular injury is a kidney manifestation following the administration of Pfizer-BioNTech COVID-19 vaccine. Minimal change disease is potentially a rare complication of Pfizer-BioNTech COVID-19 vaccine.

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