Temporal trends in serum creatinine (mg/dl), serum albumin (g/dl), and proteinuria (g/d if 24-hour sample, g/g if spot sample) are graphed over the first 5 weeks after vaccination. At the most recent follow-up, approximately 3 weeks after initiation of corticosteroids, creatinine remained elevated at 3.74 mg/dl, with 24-hour urine protein of 18.8 g/d ( Figure 2 The patient was discharged 3 days later with 19.8 g/g proteinuria by spot ratio, serum albumin of 2.9 g/dl, and serum creatinine of 2.54 mg/dl. Creatinine peaked during the hospitalization at 3.17 mg/dl at 19 days after vaccination. furosemide drip, 10 mg/h, transitioned to bumetanide, 0.25 mg/h, for 5 days for fluid overload. To optimize viewing of this image, please see the online version of this article at Empiric pulse methylprednisolone, 1 g daily for 3 days, was initiated on hospital admission, followed by oral prednisone, 60 mg daily, after biopsy. ( c) Electron microscopy demonstrates complete podocyte foot process effacement (original magnification ×8000). ( b) A low-power view shows diffuse cortical acute tubular injury with focal shedding of degenerating epithelial cells into the lumen (hematoxylin and eosin, original magnification ×200). (a) Light microscopy shows a histologically unremarkable glomerulus (hematoxylin and eosin, original magnification ×400). The ultrastructural findings of minimal segmental mesangial sclerosis and glomerular basement membrane thickening (mean, 460 nm) suggested underlying mild diabetic changes. Electron microscopy revealed 100% podocyte foot process effacement, leading to a diagnosis of minimal change disease with acute tubular injury. No immune deposits were identified by immunofluorescence (2 glomeruli) or electron microscopy (2 glomeruli). Cortical tubules displayed diffuse acute epithelial injury. There was 25% tubular atrophy and interstitial fibrosis with moderate arteriosclerosis. Among 7 glomeruli sampled for light microscopy, 4 were globally sclerotic and 3 were histologically unremarkable. Serologies included elevated C3 and C4 and negative hepatitis B surface antigen and hepatitis C antibody.Ī kidney biopsy was performed 16 days after vaccination ( Figure 1 Complete blood cell count was normal, and hemoglobin A1c was 7.5%. Laboratory evaluation by 14 days after vaccination showed 24-hour urine protein of 23.2 g/d, serum creatinine of 2.33 mg/dl, and serum albumin of 3.0 g/dl. Nephrology consultation 12 days after vaccination found anasarca with 13.6-kg weight gain due to edema, elevated blood pressure (152/81 mm Hg), and 4+ proteinuria on urinalysis with inactive urine sediment, prompting hospital admission. Laboratory testing revealed 4+ proteinuria by dipstick and serum albumin of 2.5 g/dl. Seven days after vaccination, he presented to his local physician complaining of abrupt onset of lower-extremity edema. There was no history of nonsteroidal anti-inflammatory drug use. Outpatient medications included atorvastatin, aspirin, dulaglutide, empagliflozin, glipizide, losartan, metformin, and metoprolol. Baseline serum creatinine ranged from 1.0 to 1.3 mg/dl, with no proteinuria over the previous year. Medical history included obesity, prior smoking, and coronary artery disease. We report a case of minimal change disease presenting with nephrotic syndrome 1 week after a first injection of the COVID-19 vaccine (Pfizer-BioNTech).Ī 77-year-old white male with a 15-year history of type 2 diabetes mellitus without retinopathy received a first dose of the Pfizer-BioNTech vaccine on March 17, 2021. As mass vaccinations for coronavirus disease 2019 (COVID-19) are being administered worldwide, rare reports of adverse events are emerging.
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