Minimal change disease and COVID-19 vaccination: Four cases and review of literature

Abstract

There have been multiple reports of the development of de novo or relapse of glomerular diseases after SARS-CoV-2 vaccination. While most of them have occurred with the mRNA vaccines (Pfizer/BioNTech and Moderna/NIAID), there also have been reports associated with the vector vaccines (AstraZeneca/ChAdOx1-S) vaccine and the inactivated vaccines. Minimal change disease (MCD) is one of the more common glomerular diseases noted to have been associated with the COVID-19 vaccination. We report here 4 more cases of MCD occurring in association with the COVID-19 vaccine, 3 were de novo cases, and 1 case had a relapse of MCD. We also review all the 41 cases described thus far in the literature and review potential common pathways activated by the vaccination that play a role in the pathogenesis of MCD.

New-onset minimal change disease following the Moderna COVID-19 vaccine

“…Steroid sensitivity of new-onset MCD after mRNA vaccination is often good, and there are no case reports of spontaneous remission. Most previously reported cases without underlying disease describe remission induced with steroids alone 5–30. In this case, complete remission was quickly achieved with PSL 60 mg/day (1 mg/kg), and the steroid response was particularly good.…”

“…This case highlights the rare but potential risk of MCD after mRNA vaccine administration. There are several case reports of new-onset MCD after mRNA vaccination, and the chronological causality is convincing 5–30. Although the mechanism is unclear, this case raises the question of whether the mRNA SARS-CoV-2 vaccine may lead to rapid development of MCD within a few days following vaccination.…”

“…The timing of MCD onset or relapse was reported at a median of 7 days following the first dose of the COVID-19 vaccine 33. On the other hand, four cases of new-onset MCD within 1–2 days following COVID-19 vaccination have been reported 9 14 15 27. Therefore, the COVID-19 vaccine is estimated to have the potential to trigger an immune response that leads to the development of MCD within 2 days.…”

“…The involvement of vaccination in the onset and recurrence of MCD has been known, and most cases develop within 2 weeks after vaccination. Thirty cases of new-onset MCD after COVID-19 vaccination have been reported worldwide, including 16 cases related to the Pfizer-BioNTech vaccine, 5 cases related to the Moderna vaccine, 5 cases related to the AstraZeneca vaccine, 2 cases related to the Sinovac vaccine and 2 cases related to the Janssen vaccine 5–30. Only two full case reports of new-onset MCD following the Moderna messenger RNA (mRNA)-1273 SARS-CoV-2 vaccine have been reported 12 29.…”

Relapse of minimal change disease following the third mRNA COVID-19 vaccination: a case report and literature review

“…We identified 34 cases of relapses MCD and 30 cases of new-onset MCD following COVID-19 vaccination. The clinical characteristics of cases of MCD relapse and the present case are summarized in Table 1 [ 5 – 15 ]. 28 of 34 cases relapsed after receiving mRNA-based vaccines: 24 cases after receiving the Pfizer-BioNTech vaccine and four cases after receiving the Moderna vaccine.…”