Minimal Change Disease With Severe Acute Kidney Injury Following the Oxford-AstraZeneca COVID-19 Vaccine: A Case Report

• Published in: American journal of kidney diseases Vol. 78; no. 4; pp. 607 - 610
• Main Authors: Leclerc, Simon, Royal, Virginie, Lamarche, Caroline, Laurin, Louis-Philippe
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2021; by the National Kidney Foundation, Inc
• Subjects: acute kidney injury (AKI); acute tubular injury (ATI); adverse event; Case Report; coronavirus disease 2019 (COVID-19); COVID-19 vaccine; minimal change disease (MCD); renal biopsy; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); vaccine safety; vaccine safety; acute kidney injury (AKI); minimal change disease (MCD); coronavirus disease 2019 (COVID-19); renal biopsy; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); case report; adverse event; COVID-19 vaccine; acute tubular injury (ATI)
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2021.06.008

We report a case of minimal change disease (MCD) with severe acute kidney injury (AKI) following the first injection of the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against coronavirus disease 2019 (COVID-19). A 71-year-old man with a history of dyslipidemia and a baseline serum creatinine of 0.7mg/dL presented with nephrotic syndrome, AKI, and severe hypertension 13 days after receiving the Oxford-AstraZeneca vaccine. Refractory hyperkalemia and hypervolemia with oligoanuria prompted initiation of hemodialysis. His serum albumin was 2.6g/dL and his urinary protein-creatinine ratio was 2,321mg/mmol. Given a high suspicion for rapidly progressive glomerulonephritis, empirical glucocorticoid treatment was initiated (3 methylprednisolone pulses followed by high-dose prednisone). A kidney biopsy showed MCD and acute tubular injury. Kidney function and proteinuria subsequently improved, and hemodialysis was discontinued 38 days after the start of therapy. This case describes de novo MCD after the Oxford-AstraZeneca vaccine. It adds to the few published case reports of MCD after the Pfizer-BioNTech COVID-19 vaccine. Further reports and studies will be needed to elucidate whether MCD is truly associated with COVID-19 vaccination.