Acute interstitial nephritis following SARS-CoV-2 vaccination

Wu, Henry H. L.; Li, Jennifer W C; Bow, Andrew; Woywodt, Alexander; Ponnusamy, Arvind

doi:10.1093/ckj/sfab253

Cited by 9 publications

(13 citation statements)

References 6 publications

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“…A number of case reports of tubulointerstitial nephritis have emerged more recently [2][3][4][5][6]. They have been associated with a number of different types of vaccine (including the Oxford-AstraZeneca) and although some of these cases were in comorbid patients taking multiple medications including proton pump inhibitors, other cases were in previously fit and well patients taking no regular medications, similar to the patient in our case.…”

Section: Discussionsupporting

confidence: 65%

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A case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine: a case report

et al. 2023

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Background More than 4 billion doses of the Coronavirus disease (COVID-19) vaccine have been administered worldwide but the relationship between the different vaccines and the development of renal disease is unknown. We present a case of tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine. Case presentation A previously fit and well 51-year-old female presented on 27th May 2021 with a one-month history of weight loss, fatigue, nausea, and a metallic taste. She had an acute kidney injury with a creatinine of 484 umol/L. She was on no regular medications and denied taking any over-the-counter or alternative medicines. She had received her first dose of the Oxford-AstraZeneca vaccine on 23rd March 2021 and her second dose on 20th May 2021. A renal biopsy was performed the following day. The 19 glomeruli appeared normal to light microscopy but the tubulointerstitial compartment contained a dense inflammatory infiltrate including many eosinophils. There was widespread acute tubular injury with tubulitis, but no established or longstanding atrophy. A diagnosis was made of an acute tubulointerstitial nephritis. She was commenced on oral prednisolone and her renal function improved. She did not require renal replacement therapy at any time. Conclusions To our knowledge, this was the first described case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine, although a number of cases have emerged more recently. In our case the patient was very fit and well, had no previous past medical history and had not taken any recent prescribed, over-the-counter or alternative medications. The absence of these provoking factors in our case makes the vaccine the most likely explanation for the development of tubulointerstitial nephritis although the pathophysiology behind this remains unknown. Given the unprecedented number of vaccinations being delivered around the world, nephrologists should be aware of this possible link although more research into the topic is required.

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Section: Discussionsupporting

confidence: 65%

“…The incidence of tubulointerstitial nephritis following administration of the COVID-19 vaccine is less widely reported although several cases have started to emerge within the literature [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

A case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine: a case report

et al. 2023

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“…There was a lack of clear-cut co-morbidities and risk factors which might have provided non-COVID-19 explanations for this pathology, but TIN is often an underdiagnosed and under-reported condition and causality is difficult to prove given a myriad of potential confounding factors [ 58 ]. The attention directed towards TIN is less compared to glomerular diseases and there are many unanswered questions regarding the temporal association between COVID-19 vaccination and TIN [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Intrinsic Kidney Pathology in Children and Adolescents Following COVID-19 Vaccination: A Systematic Review

Shenoy

Kalra

et al. 2022

Children

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Global COVID-19 vaccination programs for children and adolescents have been developed with international clinical trial data confirming COVID-19 mRNA vaccine safety and efficacy for the pediatric population. The impact of COVID-19 vaccination in the kidneys is thought to be explained by a complex immune-mediated relationship between the two, although the pathophysiological mechanisms of how COVID-19 vaccination potentially induces kidney pathology are not presently well known. Whilst intrinsic kidney pathologies following COVID-19 vaccination have been reported in adults, such cases are only being recently reported with greater frequency in children and adolescents. Conforming to the PRISMA checklist, we conducted a systematic review of the current literature to provide an overview on the range of intrinsic kidney pathologies that have been reported following COVID-19 vaccination in children and adolescents. All English language research articles published on or before 30 June 2022 reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following COVID-19 vaccination were selected for qualitative analysis. Out of 18 cases from the 13 published articles selected, there were 10 cases of IgA nephropathy (1 case of rapidly progressive glomerulonephritis requiring acute hemodialysis), 5 cases of minimal change disease (MCD), 1 case of concurrent MCD/tubulointerstitial nephritis (TIN) and 2 cases of TIN. There is no indication currently to avoid vaccination, unless specific circumstances exist, as the benefits of COVID-19 vaccination far outweigh its risks. Concluding the findings from our systematic review based on preliminary evidence, potential adverse effects to the kidney from COVID-19 vaccination affects a small number of children and adolescents among the many who have been vaccinated. There remains good reason at present to support vaccination of children and adolescents with a greater morbidity status, such as those living with preexisting chronic kidney disease. Close observation of all children and adolescents receiving COVID-19 vaccination is recommended, particularly in those with preceding intrinsic kidney pathology to identify risks of relapsed disease.

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“…Another patient, described by Wu et al,. developed a relapse of AIN after steroid taper, which reversed only after withdrawal of concomitant treatment with paroxetine [ 2 ]. Thus, in several of these well-documented published cases, it ultimately remained unclear to what extent the cause and magnitude of subsequent renal function impairment were clearly related to vaccination despite the detection of AIN in the biopsy.…”

Section: Lessons For the Clinical Nephrologistmentioning

confidence: 99%

“…However, causal confirmation of the relationship with vaccination remains challenging and is not always beyond doubt. Acute interstitial nephritis (AIN) has also recently been linked to SARS-CoV-2 vaccination [1][2][3][4]. Of note, in the largest series of 5 cases published to date, two patients with severely elevated serum creatinine levels of 268 and 355 µmol/l had evidence of concurrent focal segmental glomerulosclerosis on biopsy just 3 days and "a few days", respectively, after vaccination, suggesting that renal disease was likely pre-existing.…”

Section: Lessons For the Clinical Nephrologistmentioning

confidence: 99%

Biopsy-proven acute interstitial nephritis after SARS-CoV-2 mRNA vaccination—adverse vaccine side effect or unrelated complication from self-medication? Lessons for the clinical nephrologist

et al. 2022

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Acute interstitial nephritis following SARS-CoV-2 vaccination

Cited by 9 publications

References 6 publications

A case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine: a case report

A case of acute tubulointerstitial nephritis following administration of the Oxford-AstraZeneca COVID-19 vaccine: a case report

Intrinsic Kidney Pathology in Children and Adolescents Following COVID-19 Vaccination: A Systematic Review

Biopsy-proven acute interstitial nephritis after SARS-CoV-2 mRNA vaccination—adverse vaccine side effect or unrelated complication from self-medication? Lessons for the clinical nephrologist

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