COVID-19 Vaccine-Induced Minimal Change Disease Nephropathy: A Rare Complication

Introduction: There have been more than 11 billion doses of the COVID-19 vaccine administered worldwide thus far. These vaccines are Pfizer/BioNTech as well the Moderna/NIAID vaccines, AstraZeneca COVID-19 vaccine and Janssen COVID-19 vaccine. There have been multiple reports of the development of de novo or relapse of glomerular diseases after SARS-CoV-2 vaccination. The involvement of immunization in the onset and recurrence of MCD has been known, and most cases develop within 2 weeks after vaccination and the exact pathogenesis has not yet been elucidated, injury of podocytes. Case Description: Case of 61 y/o F patient with PMHx of chronic cystitis, fibroadenoma who went to the PCP for a routine evaluation and was found with proteinuria and referred to nephrology clinic. Patients referred 2 weeks before labs were taken were vaccinated against COVID-19. A serial laboratory was done including, rheumatology, inflammatory and was found negative. Biopsy was performed and found with global effacement of foot process w/o overt immune deposits, this pattern represents minimal change disease. Laboratory w/u showed gross proteinuria of 1.1 grams and started with ACEi, but the patient refers some episodes of hypotension and used medication intermittently, that increased proteinuria to 1.6 grams. The patient continues increasing proteinuria to 1.7 grams despite ACEi. A second biopsy was performed, and same diagnosis was reported. Then it is decided to start SGLT2i, despite the patient continuing with proteinuria to reach 2.1 grams. PCP started a low dose of steroids 20 mg and proteinuria started to decrease to 748, 397, and 280 grams respectively, after that patient began tapering down prednisone. The patient continues with a F/U nephrologist and was found to decrease proteinuria in 223 mg. Discussion: This case highlights the rare but potential risk of MCD following COVID-19 vaccination. Clinicians should be aware of nephrotic syndrome as a possible post-vaccine complication. However, it is important to note that with the vast number of vaccines administered to date worldwide, only very rare occurrences of de novo MCD have been reported. Although this adverse event is uncommon, considering the limited published data and the absence of confirmed causality. Increased awareness is essential for early diagnosis and optimal treatment of affected patients.