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. 2022 May 6;15(8):1574-1582.
doi: 10.1093/ckj/sfac134. eCollection 2022 Aug.

Idiopathic nephrotic syndrome relapse following COVID-19 vaccination: a series of 25 cases

Aurélie Hummel  1 , Julie Oniszczuk  2 , Delphine Kervella  3 , Marina Charbit  4 , Dominique Guerrot  5 , Angelo Testa  6 , Carole Philipponnet  7 , Cécile Chauvet  8 , Thomas Guincestre  9 , Karine Brochard  10 , Ariane Benezech  10 , Lucile Figueres  3 , Xavier Belenfant  11 , Andrea Guarnieri  12 , Nathalie Demoulin  13 , Elisa Benetti  14 , Marius Miglinas  15 , Kathleen Dessaix  16 , Johann Morelle  13 , Andrea Angeletti  17 , Anne-Laure Sellier-Leclerc  18 , Bruno Ranchin  18 , Guillaume Goussard  19 , Laurent Hudier  20 , Justine Bacchetta  18 , Aude Servais  1 , Vincent Audard  2
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Idiopathic nephrotic syndrome relapse following COVID-19 vaccination: a series of 25 cases

Aurélie Hummel et al. Clin Kidney J. .

Abstract

Background: Several cases of idiopathic nephrotic syndrome (INS) relapse following the administration of coronavirus disease 2019 (COVID-19) vaccines have recently been reported, raising questions about the potential relationship between the immune response to COVID-19 vaccination and INS pathogenesis.

Methods: We performed a retrospective multicentre survey describing the clinical and biological characteristics of patients presenting a relapse of INS after COVID-19 vaccination, with an assessment of outcome under treatment.

Results: We identified 25 patients (16 men and 9 women) presenting a relapse within 1 month of a COVID-19 vaccine injection. The glomerular disease was of childhood onset in half of the patients and most patients (21/25) had received at least one immunosuppressive drug in addition to steroids for frequently relapsing or steroid-dependent nephrotic syndrome (NS). All patients were in a stable condition at the time of injection and 11 had no specific treatment. In five patients, the last relapse was reported >5 years before vaccine injection. The Pfizer-BioNTech (BNT162b2) vaccine was used in 80% of the patients. In 18 cases, INS relapse occurred after the first injection, a mean of 17.5 days after vaccination. A second injection was nevertheless administered in 14 of these patients. Five relapses occurred after administration of the second dose and two relapses after the administration of the third dose. All but one of the patients received steroids as first-line treatment, with an additional immunosuppressive agent in nine cases. During follow-up, complete remission was achieved in 21 patients, within 1 month in 17 cases. Only one patient had not achieved at least partial remission after 3 months of follow-up.

Conclusions: This case series suggests that, in rare patients, COVID-19 vaccination may trigger INS relapse that is generally easy to control. These findings should encourage physicians to persuade their patients to complete the COVID-19 vaccination schedule.

Keywords: COVID-19; idiopathic nephrotic syndrome; minimal change disease; relapse; vaccination.

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