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28-07-2023 | Nephrotic Syndrome | Systematic Reviews

Nephrotic syndrome following COVID-19 vaccination: a systematic review

Authors: Charmy Parikh, Henil Upadhyay, Suyog Patel, Ramaswamy Sundararajan, Dhairya Shah, Ayush Anand, Bhavana Baraskar, Tulsi Bhatt, Deepak Verma, Shubham Agrawal, Amol Mittal, Sanjeev Gupta

Published in: Journal of Nephrology | Issue 9/2023

Abstract

Background

Severe acute respiratory syndrome coronavirus 2 infection has caused significant morbidity and mortality. Vaccines produced against this virus have proven highly effective. However, adverse events following vaccination have also been reported. One of them is nephrotic syndrome, that can be associated with different pathologic pictures. This review aims to provide a wider understanding of incidence, etiopathogenesis, and management of nephrotic syndrome following vaccination against SARS-CoV-2.

Methods and results

A literature search was undertaken using appropriate keywords in various databases like PubMed, Google Scholar, Europe PMC, and Science Direct. Twenty-one articles were included following qualitative assessment. Data of 74 patients from these articles were included.

Discussion

The pathogenesis of nephrotic syndrome following COVID vaccination has been widely attributed to the activation of angiotensin-converting enzyme-2 receptors, leading to podocyte effacement. Relapses have also been reported in patients with prior history of nephrotic syndrome following COVID-19 vaccination. A renal biopsy is necessary to identify the histopathological picture. Management of COVID-19 vaccine-induced nephrotic syndrome was mainly reported as successfully attainable with corticosteroids and supportive management.

Conclusion

Further investigations will help in establishing an early diagnosis and salvaging kidney function.

Graphical abstract

Hu B, Guo H, Zhou P, Shi ZL (2020) Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol 19(19):1–14. https://doi.org/10.1038/s41579-020-00459-7CrossRef

Gupta A, Madhavan MV, Sehgal K et al (2020) Extrapulmonary manifestations of COVID-19. Nat Med 26(7):1017–1032. https://doi.org/10.1038/s41591-020-0968-3CrossRefPubMed

World Health Organization (2022) WHO COVID-19 dashboard. World Health Organization. https://covid19.who.int/. Accessed 1 June 2022

Pascual-Iglesias A, Canton J, Ortega-Prieto AM, Jimenez-Guardeño JM, Regla-Nava JA (2021) An overview of vaccines against SARS-CoV-2 in the COVID-19 pandemic era. Pathogens 10(8):1030. https://doi.org/10.3390/pathogens10081030CrossRefPubMedPubMedCentral

(2021) COVID-19 vaccines: acting on the evidence. Nat Med 27(2):183–183. doi: https://doi.org/10.1038/s41591-021-01261-5

COVID-19. vac-lshtm.shinyapps.. https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/io. Accessed 26 July 2020

Cohen AF, Gerven J, Burgos JG et al (2020) COVID-19 vaccines: the importance of transparency and fact-based education. Br J Clin Pharmacol 86(11):2107–2110. https://doi.org/10.1111/bcp.14581CrossRefPubMedPubMedCentral

Bomback AS, Kudose S, D’Agati VD (2021) De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far? Am J Kidney Dis 78(4):477–480. https://doi.org/10.1053/j.ajkd.2021.06.004CrossRefPubMedPubMedCentral

Leclerc S, Royal V, Lamarche C, Laurin LP (2021) Minimal change disease with severe acute kidney injury following the oxford-astrazeneca COVID-19 vaccine: a case report. Am J Kidney Dis 78(4):607–610. https://doi.org/10.1053/j.ajkd.2021.06.008CrossRefPubMedPubMedCentral

10.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

11.

Lebedev L, Sapojnikov M, Wechsler A et al (2021) Minimal change disease following the Pfizer-BioNTech COVID-19 vaccine. Am J Kidney Dis 78(1):142–145. https://doi.org/10.1053/j.ajkd.2021.03.010CrossRefPubMedPubMedCentral

12.

Abdulgayoom M, Albuni MK, Abdelmahmuod E, Murshed K, Eldeeb Y (2021) Minimal change nephrotic syndrome four days after the administration of Pfizer-BioNTech COVID-19 vaccine—a new side effect or coincidence? Clin Case Rep. https://doi.org/10.1002/ccr3.5003CrossRefPubMedPubMedCentral

13.

Thappy S, Thalappil SR, Abbarh S, Al-Mashdali A, Akhtar M, Alkadi MM (2021) Minimal change disease following the Moderna COVID-19 vaccine: first case report. BMC Nephrol. https://doi.org/10.1186/s12882-021-02583-9CrossRefPubMedPubMedCentral

14.

Hanna J, Ingram A, Shao T (2021) 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. Can J Kidney Health Dis 8:205435812110582. https://doi.org/10.1177/20543581211058271CrossRef

15.

Lim JH, Han MH, Kim YJ et al (2021) New-onset nephrotic syndrome after Janssen COVID-19 vaccination: a case report and literature review. J Korean Med Sci. https://doi.org/10.3346/jkms.2021.36.e218CrossRefPubMedPubMedCentral

16.

Kobayashi S, Fugo K, Yamazaki K, Terawaki H (2021) Minimal change disease soon after Pfizer-BioNTech COVID-19 vaccination. Clin Kidney J. https://doi.org/10.1093/ckj/sfab156CrossRefPubMedPubMedCentral

17.

Unver S, Haholu A, Yildirim S (2021) Nephrotic syndrome and acute kidney injury following CoronaVac anti-SARS-CoV-2 vaccine. Clin Kidney J. https://doi.org/10.1093/ckj/sfab155CrossRefPubMedPubMedCentral

18.

Biradar V, Konnur A, Gang S et al (2021) Adult-onset nephrotic syndrome following COVID-19 vaccination. Clin Kidney J. https://doi.org/10.1093/ckj/sfab153CrossRefPubMedPubMedCentral

19.

Nakazawa E, Uchimura T, Hirai Y et al (2021) New-onset pediatric nephrotic syndrome following Pfizer-BioNTech SARS-CoV-2 vaccination: a case report and literature review. CEN Case Rep 11(2):242–246. https://doi.org/10.1007/s13730-021-00656-0CrossRefPubMedPubMedCentral

20.

Hartley JL, Bailey N, Sharma A, Shawki H (2022) Nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine: two cases. BMJ Case Rep 15(3):e244638. https://doi.org/10.1136/bcr-2021-244638CrossRefPubMedPubMedCentral

21.

Marinaki S, Kolovou K, Liapis G, Skalioti C, Tsiakas S, Boletis I (2021) De novo minimal change disease following vaccination with the Pfizer/BioNTech SARS-CoV-2 vaccine in a living kidney donor. Medicina 58(1):37. https://doi.org/10.3390/medicina58010037CrossRefPubMedPubMedCentral

22.

Klomjit N, Alexander MP, Fervenza FC et al (2021) COVID-19 vaccination and glomerulonephritis. Kidney Int Rep 6(12):2969–2978. https://doi.org/10.1016/j.ekir.2021.09.008CrossRefPubMedPubMedCentral

23.

Pella E, Sarafidis PA, Alexandrou ME et al (2022) De novo minimal change disease in an adolescent after Pfizer-BioNTech COVID-19 vaccination: a case report. Case Rep Nephrol Dial 12(1):44–49. https://doi.org/10.1159/000521981CrossRefPubMedPubMedCentral

24.

Marega A, Pizzolitto S, Pian M et al (2022) MO230: de novo double glomerulopathy (Membranous Nephropathy, Mn and Collapsing Focal Segmental Glomerulosclerosis, CFSGS) associated to positive myeloperoxidase-O (MPO) antibody following pfizer-biontech MRNA vaccination Covid 19. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfac067.029CrossRef

25.

Rashid W, Mousa H, Khan J, Ijaz F, Ezell GD (2022) A Case of membranous nephropathy hypothesized to be associated with COVID-19 vaccine. Cureus. https://doi.org/10.7759/cureus.24245CrossRefPubMedPubMedCentral

26.

Fenoglio R, Lalloni S, Marchisio M et al (2022) New onset biopsy-proven nephropathies after COVID vaccination. Am J Nephrol 53(4):325–330. https://doi.org/10.1159/000523962CrossRefPubMed

27.

Mancianti N, Guarnieri A, Tripodi S, Salvo DP, Garosi G (2021) Minimal change disease following vaccination for SARS-CoV-2. J Nephrol. https://doi.org/10.1007/s40620-021-01091-1CrossRefPubMedPubMedCentral

28.

Mochizuki RI, Takahashi N, Ikenouchi K, Shoda W, Kuyama T, Takahashi D (2022) A de novo case of minimal change disease following the first dose of the Moderna mRNA-1273 SARS-CoV-2 vaccine without relapse after the second dose. CEN Case Rep. https://doi.org/10.1007/s13730-022-00702-5CrossRefPubMedPubMedCentral

29.

Alhosaini MN (2022) A case of minimal change disease after SARS-CoV-2 vaccination under the age of 18. Avicenna J Med 12(01):031–033. https://doi.org/10.1055/s-0042-1743209CrossRef

30.

Hummel A, Oniszczuk J, Kervella D et al (2022) Idiopathic nephrotic syndrome relapse following COVID-19 vaccination: a series of 25 cases. Clin Kidney J. https://doi.org/10.1093/ckj/sfac134CrossRefPubMedPubMedCentral

31.

Izzedine H, Bonilla M, Jhaveri KD (2021) Nephrotic syndrome and vasculitis following SARS-CoV-2 vaccine: true association or circumstantial? Nephrol Dial Transplant 36(9):1565–1569. https://doi.org/10.1093/ndt/gfab215CrossRefPubMed

32.

Barda N, Dagan N, Ben-Shlomo Y et al (2021) Safety of the BNT162b2 mRNA Covid-19 vaccine in a nationwide setting. N Engl J Med. https://doi.org/10.1056/nejmoa2110475CrossRefPubMedPubMedCentral

33.

Sugita K, Kaneko S, Hisada R et al (2022) Development of IgA vasculitis with severe glomerulonephritis after COVID-19 vaccination: a case report and literature review. CEN Case Rep. https://doi.org/10.1007/s13730-022-00695-1CrossRefPubMedPubMedCentral

34.

Maye JA, Chong HP, Rajagopal V, Petchey W (2021) Reactivation of IgA vasculitis following COVID-19 vaccination. BMJ Case Rep 14(11):e247188. https://doi.org/10.1136/bcr-2021-247188CrossRefPubMedPubMedCentral

35.

Obeid M, Fenwick C, Pantaleo G (2021) Reactivation of IgA vasculitis after COVID-19 vaccination. Lancet Rheumatol 3(9):e617. https://doi.org/10.1016/s2665-9913(21)00211-3CrossRefPubMedPubMedCentral

36.

Sekar A, Campbell R, Tabbara J, Rastogi P (2021) ANCA glomerulonephritis after the Moderna COVID-19 vaccination. Kidney Int 100(2):473–474. https://doi.org/10.1016/j.kint.2021.05.017CrossRefPubMedPubMedCentral

37.

Gueguen L, Loheac C, Saidani N, Khatchatourian L (2021) Membranous nephropathy following anti-Covid-19 mRNA vaccination. Kidney Int. https://doi.org/10.1016/j.kint.2021.08.006CrossRefPubMedPubMedCentral

38.

Holzworth A, Couchot P, Cruz-Knight W, Brucculeri M (2021) Minimal change disease following the Moderna mRNA-1273 SARS-CoV-2 vaccine. Kidney Int 100(2):463–464. https://doi.org/10.1016/j.kint.2021.05.007CrossRefPubMedPubMedCentral

39.

Tapia C, Khalid Bashir. Nephrotic Syndrome. Nih.gov. Published January 13, 2019. https://www.ncbi.nlm.nih.gov/books/NBK470444/. Accessed 15 June 2022

40.

Vivarelli M, Massella L, Ruggiero B, Emma F (2016) Minimal change disease. Clin J Am Soc Nephrol 12(2):332–345. https://doi.org/10.2215/cjn.05000516CrossRefPubMedPubMedCentral

41.

Colucci M, Corpetti G, Emma F, Vivarelli M (2017) Immunology of idiopathic nephrotic syndrome. Pediatr Nephrol 33(4):573–584. https://doi.org/10.1007/s00467-017-3677-5CrossRefPubMed

42.

Kielstein JT, Termühlen L, Sohn J, Kliem V (2000) Minimal change nephrotic syndrome in a 65-year-old patient following influenza vaccination. Clin Nephrol 54(3):246–248PubMed

43.

Kuzemko JA (1972) Measles vaccination and the nephrotic syndrome. BMJ 4(5841):665–666. https://doi.org/10.1136/bmj.4.5841.665-aCrossRefPubMedPubMedCentral

44.

Macário F, Freitas L, Correia J et al (1995) Nephrotic syndrome after recombinant hepatitis B vaccine. Clin Nephrol 43:349PubMed

45.

Kikuchi Y, Imakiire T, Hyodo T et al (2002) Minimal change nephrotic syndrome, lymphadenopathy and hyperimmunoglobulinemia after immunization with a pneumococcal vaccine. Clin Nephrol 58(07):68–72. https://doi.org/10.5414/cnp58068CrossRefPubMed

46.

Folegatti P, Ewer K, Aley P et al (2020) Articles Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. The Lancet. https://doi.org/10.1016/S0140-6736(20)31604-4CrossRefPubMed

47.

Sahin U, Muik A, Vogler I et al (2021) BNT162b2 vaccine induces neutralizing antibodies and poly-specific T cells in humans. Nature 595(7868):572–577. https://doi.org/10.1038/s41586-021-03653-6CrossRefPubMed

48.

Yang J, Petitjean SJL, Koehler M et al (2020) Molecular interaction and inhibition of SARS-CoV-2 binding to the ACE2 receptor. Nat Commun 11(1):4541. https://doi.org/10.1038/s41467-020-18319-6CrossRefPubMedPubMedCentral

49.

Gupta RK, Bhargava R, Shaukat AA, Albert E, Leggat J (2020) Spectrum of podocytopathies in new-onset nephrotic syndrome following COVID-19 disease: a report of 2 cases. BMC Nephrol. https://doi.org/10.1186/s12882-020-01970-yCrossRefPubMedPubMedCentral

50.

Kodner C (2009) Nephrotic syndrome in adults: diagnosis and management. Am Fam Physician 80(10):1129–1134PubMed

51.

Kodner C (2016) Diagnosis and management of nephrotic syndrome in adults. American Family Physician 93(6):479–485. http://www.ncbi.nlm.nih.gov/pubmed/26977832. Accessed 5 June 2022

52.

Hull RP, Goldsmith DJA (2008) Nephrotic syndrome in adults. BMJ 336(7654):1185–1189. https://doi.org/10.1136/bmj.39576.709711.80CrossRefPubMedPubMedCentral

53.

Hull KL, Adenwalla SF, Topham P, Graham-Brown MP (2022) Indications and considerations for kidney biopsy: an overview of clinical considerations for the non-specialist. Clin Med 22(1):34–40. https://doi.org/10.7861/clinmed.2021-0472CrossRef

54.

Dirim AB, Safak S, Andac B et al (2021) Minimal change disease following vaccination with CoronaVac. Clin Kidney J 14(10):2268–2269. https://doi.org/10.1093/ckj/sfab123CrossRefPubMedPubMedCentral

55.

Rheault MN (2016) Nephrotic syndrome: updates and approaches to treatment. Curr Treat Opt Pediatr 2(2):94–103. https://doi.org/10.1007/s40746-016-0044-xCrossRef

56.

Bansal S, Perincheri S, Fleming T et al (2021) Cutting edge: circulating exosomes with COVID spike protein are induced by BNT162b2 (Pfizer-BioNTech) vaccination prior to development of antibodies: a novel mechanism for immune activation by mRNA vaccines. J Immunol 207(10):2405–2410. https://doi.org/10.4049/jimmunol.2100637CrossRefPubMed

57.

Buchan SA, Seo CY, Johnson C et al (2022) Epidemiology of myocarditis and pericarditis following mRNA vaccination by vaccine product, schedule, and interdose interval among adolescents and adults in Ontario, Canada. JAMA Netw Open 5(6):e2218505. https://doi.org/10.1001/jamanetworkopen.2022.18505. (Published 2022 Jun 1)CrossRefPubMedPubMedCentral

58.

Baumeier C, Aleshcheva G, Harms D et al (2022) Intramyocardial inflammation after COVID-19 vaccination: an endomyocardial biopsy-proven case series. Int J Mol Sci 23(13):6940. https://doi.org/10.3390/ijms23136940CrossRefPubMedPubMedCentral

Title: Nephrotic syndrome following COVID-19 vaccination: a systematic review
Authors: Charmy Parikh
Henil Upadhyay
Suyog Patel
Ramaswamy Sundararajan
Dhairya Shah
Ayush Anand
Bhavana Baraskar
Tulsi Bhatt
Deepak Verma
Shubham Agrawal
Amol Mittal
Sanjeev Gupta
Publication date: 28-07-2023
Publisher: Springer International Publishing
Keywords: Nephrotic Syndrome
COVID-19 Vaccination
Vaccination
Rituximab
Rituximab
Post-COVID Syndrome
COVID-19
Published in: Journal of Nephrology / Issue 9/2023
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-023-01710-z

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