Atypical Hemolytic Uremic Syndrome Occurring After Receipt of mRNA-1273 COVID-19 Vaccine Booster: A Case Report

Claes, Kathleen; Geerts, Inge; Lemahieu, Wim; Wilmer, Alexander; Kuypers, Dirk RJ.; Koshy, Priyanka; Ombelet, Sara

doi:10.1053/j.ajkd.2022.07.012

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…In one patient with dubious aHUS relapse, we cannot exclude that aHUS episode could have been diagnosed more profoundly and earlier if TMA parameters were assessed at the time of the start of symptoms. Our data confirms the findings of three adult cases with a pathogenic complement variant, who developed aHUS 1-6 days after BNT162b2, ChAdOx1 nCoV, or mRNA-1273 vaccination (19)(20)(21). In addition, two cases of, respectively, a Caucasian and African adult patient who developed TMA onset 5 and 10 days after ChAdOx1 nCoV vaccination have been reported (25, 26).…”

Section: Discussionsupporting

confidence: 90%

“…In addition, a second or third COVID-19 vaccination has been statistically significant associated with (non-aHUS) glomerular disease relapse (15). Sporadically, patients developed complement-mediated HUS after COVID-19 infection and, even more rare, COVID-19 vaccination (14,(16)(17)(18)(19)(20)(21). Yet to date it is unknown to what degree vaccination against COVID-19 could trigger aHUS in pediatric and adult patients with a pathogenic complement variant.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 vaccination and Atypical hemolytic uremic syndrome

Bouwmeester

Bormans

Duineveld³

et al. 2022

Front. Immunol.

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IntroductionCOVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.Methods and ResultsHere we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days (range 2-15) after mRNA-based (Pfizer/BioNTech’s, BNT162b2) or adenoviral (AstraZeneca, ChAdOx1 nCoV-19) COVID-19 vaccination. All three patients presented with evident hematological signs of TMA and AKI, and other aHUS triggering or explanatory events were absent. After eculizumab treatment, kidney function fully recovered in 2/3 patients. In addition, we describe two patients with dubious aHUS relapse after COVID-19 vaccination. To assess the risks of vaccination, we retrospectively evaluated 29 aHUS patients (n=8 with native kidneys) without complement-inhibitory treatment, who received a total of 73 COVID-19 vaccinations. None developed aHUS relapse after vaccination.ConclusionIn conclusion, aHUS should be included in the differential diagnosis of patients with vaccine-induced thrombocytopenia, especially if co-occuring with mechanical hemolytic anemia (MAHA) and acute kidney injury (AKI). Still, the overall risk is limited and we clearly advise continuation of COVID-19 vaccination in patients with a previous episode of aHUS, yet conditional upon clear patient instruction on how to recognize symptoms of recurrence. At last, we suggest monitoring serum creatinine (sCr), proteinuria, MAHA parameters, and blood pressure days after vaccination.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

COVID-19 vaccination and Atypical hemolytic uremic syndrome

Bouwmeester

Bormans

Duineveld³

et al. 2022

Front. Immunol.

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“…We summarized 17 patients diagnosed with aHUS associated with COVID-19 vaccination (Table 2, cases 1-17), [50][51][52][53][54][55][56][57][58][59][60][61][62] with a median age of 43.0 (12-69) years. Females were the predominant group (64.7%).…”

Section: Ahus and Covid-19 Vaccinationmentioning

confidence: 99%

“…A total of 84 cases of TMA associated with COVID‐19 vaccination were found in 58 articles, 2,9–65 including 64 patients diagnosed with TTP (Table 1), 17 cases manifested as aHUS (Table 2, cases 1–17), and three patients presented as unclassified TMA (Table 2, cases 18–20). Subsequently, relevant clinical records were extracted for analysis, including baseline characteristics, laboratory tests, treatment options, and outcomes.…”

Section: Clinical Characteristics Of Tma Patients Associated With Cov...mentioning

confidence: 99%

New‐onset and relapsed thrombotic microangiopathy post‐COVID‐19 vaccination

2023

Journal of Medical Virology

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Thrombotic microangiopathy (TMA) associated with coronavirus disease 2019 (COVID-19) vaccination has been reported, however, the clinical characteristics and pathogenesis remained mysterious. We reviewed 84 TMA cases post-COVID-19 vaccination, including 64 patients diagnosed with thrombotic thrombocytopenic purpura (TTP), 17 cases presented as atypical hemolytic uremic syndrome (aHUS), and three cases manifested as unclassified TMA. TMA episodes were mostly associated with messenger RNA vaccines. For TTP, 67.6% of females developed symptoms after the first dose of the vaccine, and 63.0% of males were secondary to the second dose (p = 0.015). Compared with TTP, aHUS generally appeared within 7 days (p = 0.002) and showed higher levels of serum creatinine (p < 0.001). 87.5% of TTP received plasma exchange (PEX)-based treatment, and 52.9% of aHUS adopted non-PEX-based therapies (p < 0.001). Mechanistically, complement dysfunction, neutrophil activation, and the generation of pathogenic autoantibodies resulting from molecular mimicry contribute to explaining the pathogenesis of TMA post-COVID-19 vaccination.

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“…Interestingly, isolated case reports described the occurrence of renal TMA in AAV patients, an association that may pose diagnostic and therapeutic challenges. [25–31] In addition, some cases of both de novo and relapses of AAV and/or TMAs after anti-SARS-CoV2 vaccination have been reported [32–53]…”

Section: Introductionmentioning

confidence: 99%

End stage renal disease in patient with microscopic polyangiitis and atypical hemolytic-uremic syndrome arose 3 weeks after the third dose of anti-SARS-CoV2 vaccine mRNA-1273: A case report with literature revision

Moronti,

Carubbi,

Sollima

et al. 2023

Medicine

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Rationale: Immune system deregulation, including AAV, is a key event that may potentially evolve into ESRD. Abnormal activation of the cAP is also a cardinal feature of TMA, particularly aHUS. The kidney is the most frequently involved organ, and renal-limited forms of TMA are often encountered in clinical practice. Isolated case reports described the occurrence of renal TMA in AAV patients. Some cases of both de novo and relapses of AAV and/or TMAs after anti-SARS-CoV2 vaccination have been reported. We reported, for the 1st time, a case of patients with new-onset MPA and aHUS occurring 3 weeks after the third dose of mRNA-1273 vaccine anti-SARS-CoV2. Patient concerns: We present a 67-year-old man, affected by arterial hypertension, reported, after mRNA-1273 vaccine anti-SARS-CoV2, anuria, fatigue, anorexia and nausea. Laboratory data revealed acute renal failure. Diagnosis: Positivity of MPO-ANCA was observed. 7 days after admission, we observed a worsening of anemia and thrombocytopenia with haptoglobin reduction, LDH increase and presence of schistocytes. Plasma levels of ADAMTS-13 were normal. A renal biopsy was performed, and findings were consistent with microscopic polyangiitis, with features of micro-thrombotic glomerulopathy. Genetic tests revealed absence of hybrid genes associated with the increased risk of aHUS. Interventions and outcomes: We started renal replacement treatment, including hemodialysis, and pulsed methylprednisolone, with no improvement of laboratory parameters. Then, plasma exchange was performed leading to partial haematological response. Only with Eculizumab, a human C5 inhibitor, we observed a normalization of haptoglobin levels and platelets’ count. However, three months after discharge, the patient still required hemodialysis. Lessons: To our knowledge we observed the first case aHUS, without genetic predisposition, associated with MPA occurring after the third dose of anti-SARS-CoV2 vaccine. This case report highlights the potential link between anti-SARS-CoV2 vaccine as a trigger of MPA and aHUS. This systematic review offers additional perspectives. It is plausible to hypothesize that the vaccine was the trigger for the development of these 2 diseases. Solid evidence on the mechanisms of interaction between vaccine and immune system, the role of genetic predisposition, and other variables, will shed additional light on the controversial link between anti-SARS-CoV2 vaccine and autoimmunity.

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Atypical Hemolytic Uremic Syndrome Occurring After Receipt of mRNA-1273 COVID-19 Vaccine Booster: A Case Report

Cited by 10 publications

References 19 publications

COVID-19 vaccination and Atypical hemolytic uremic syndrome

COVID-19 vaccination and Atypical hemolytic uremic syndrome

New‐onset and relapsed thrombotic microangiopathy post‐COVID‐19 vaccination

End stage renal disease in patient with microscopic polyangiitis and atypical hemolytic-uremic syndrome arose 3 weeks after the third dose of anti-SARS-CoV2 vaccine mRNA-1273: A case report with literature revision

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