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

Abstract

In recent times, new onset or relapse of nephrotic syndrome following the first dose of SARS-CoV-2 vaccines has been reported. Although the vaccination could trigger nephrotic syndrome, the question of whether the same vaccine should be administered as the second dose remains unanswered. A 25-year-old woman had taken the Moderna mRNA-1273 SARS-CoV-2 vaccine (mRNA-1273) and 26 days later, she noticed facial and peripheral edema. One week later she was referred and admitted to our hospital, wherein laboratory tests revealed that her serum creatinine level, serum albumin level, and urine protein–creatinine ratio were respectively 0.79 mg/dL, 2.5 g/dL, and 7.0 g/gCr. After a thorough inpatient examination including renal biopsy, she was diagnosed with minimal change disease (MCD) and treatment with steroids was initiated. She achieved complete remission the next day and did not experience a relapse upon receiving the second mRNA-1273 dose 56 days after the first, under treatment with 35 mg/day of oral prednisolone. This case report yields insight into determining whether patients who develop de novo MCD after the first mRNA-1273 dose should receive the second dose.

Renal Complications Following COVID-19 Vaccination: A Narrative Literature Review

“…[ 3 , 53 ] Many studies proposed that there could be aberrant activation of the immune system in genetically susceptible individuals,[ 20 ] causing a dysregulated T-cell response. [ 15 , 16 , 45 ] This was found to cause alterations in glomerular permeability due to the production of glomerular permeability factor, causing diffuse foot process effacement. [ 16 ] This eventually leads to T-cell-mediated podocyte injury.…”

“…Conversely, Mochizuki et al . [ 15 ] reported a case of de novo minimal change disease in a 25-year-old woman after the first dose of Moderna mRNA-1273 vaccination, which had complete remission following steroid therapy. They have also found that there is no relapse of renal complications following second dose vaccination and suggested that it may be safe to administer the subsequent dose vaccination alongside immunosuppressive treatment to achieve complete remission of renal complications developed.…”

“…[ 8 , 58 ] The causality between COVID-19 vaccination and the occurrence of these complications remains to be unclear. So far, only a temporal relationship has been established and various pathogenic mechanisms, including molecular mimicry,[ 8 , 20 , 33 , 45 , 46 ] delayed hypersensitivity,[ 6 , 39 ] transient systemic cytokine response,[ 2 , 33 , 35 ] dysregulated T-cell response,[ 15 - 20 , 45 ] and others, have been hypothesized to explain the occurrence of renal complications in COVID-19- vaccinated individuals. Most of the cases were found to be resolved with the administration of appropriate therapy such as steroids.…”

“… Most of the cases were found to be resolved with the administration of appropriate therapy such as steroids. [ 15 ] However, early diagnosis plays a crucial role in better management and preventing further worsening of these complications. …”

“… IgA nephropathy (IgAN)[ 2 – 12 ] IgA vasculitis with severe glomerulonephritis[ 13 ] De novo and relapsing necrotizing vasculitis[ 14 ] Minimal change disease (MCD)[ 15 – 18 ] Minimal change disease with IgAN[ 19 ] Minimal change disease with severe acute kidney injury[ 20 ] Minimal change glomerulonephritis[ 21 ] Membranous nephropathy (MN)[ 22 - 24 ] Anti-glomerular basement membrane antibody disease (Anti-GBM)[ 25 ] IgG4-related disease (IgG4-RD)[ 26 ] Lupus nephritis (LN)[ 27 ] Scleroderma renal crisis[ 28 ] Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis[ 29 ] ANCA-associated vasculitis[ 30 - 32 ] ANCA-associated vasculitis presenting with rhabdomyolysis and pauci-immune crescentic glomerulonephritis[ 33 ] Myeloperoxidase-antineutrophilic cytoplasmic antibody-associated vasculitis (MPO-ANCA)[ 34 ] Anti-neutrophil cytoplasmic antibody-associated vasculitis with acute renal failure[ 35 ] Acute interstitial nephritis[ 36 - 39 ] Acute kidney injury (AKI)[ 10 , 40 ] Pre-renal AKI[ 41 ] COVID-19 vaccine-associated glomerular disease (CVAGD)[ 42 - 45 ] Acute tubular necrosis (ATN)[ 46 ] Acute tubulointerstitialnephritis[ 47 - 49 ] Nephroticsyndrome[ 50 - 54 ] New-onset pediatric nephroticsyndrome[ 55 ] Renal thrombotic microangiopathy[ 56 ] Focal segmental glomerulosclerosis[ 57 ] Glomerulonephritis[ 46 , …”