COVID-19 vaccination and Atypical hemolytic uremic syndrome

Abstract

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.

Atypical hemolytic uremic syndrome in a patient with HIV treated with eculizumab: A case report

“…Among them, the direct cytopathic damage induced by HIV in the endothelium, as well as the opportunistic pathogens, the related malignant neoplasms and the drugs that are used as treatment [5] . Although so far the relationship between aSHU and vaccination against SARS-CoV2 is weak, there are cases in which TMA has been identified as a manifestation of structural-histological and functional renal involvement, although the association with glomerular pathology precipitated by immunization against the virus is more common [6] , [7] , [8] , [9] . In this case, aSHU associated with vaccination used to prevent COVID-19 was not considered because of the temporality between the events.…”

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

“…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%).…”

“…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.…”

Necrotizing pancreatitis, microangiopathic hemolytic anemia and thrombocytopenia following the second dose of Pfizer/BioNTech COVID-19 mRNA vaccine

“…Pancreatitis after Pfizer/BioNTech COVID-19 vaccination has been reported in only 10 patients [ 2 – 11 ]. Thrombotic microangiopathy and hemolytic-uremic syndrome after Pfizer/BioNTech COVID-19 vaccination has been reported in two cases [ 12 , 13 ]. For all these reports, it is not possible to decide unequivocally whether there is a causal connection or just a random confluence of the events.…”