New-onset Nephrotic Syndrome with Minimal Change Disease Following Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review

Abstract

Background: Vaccination is underway in tremendous numbers worldwide while COVID-19 infection remains serious. Relapse of nephrotic syndrome following vaccination during the remission phase has been reported, and a causal relationship has been considered. However, new-onset nephrotic syndrome in the background of large-scale vaccinations over a short period of time may be incidental and unrelated to the vaccine.Case Presentatio: A 40-year-old Japanese woman with no history of kidney disease developed nephrotic syndrome following the first dose of Pfizer-BioNTech COVID-19 vaccine, which rapidly resolved with corticosteroid pulse therapy. She presented with a significant weight gain and anasarca 1 week after the vaccination. Laboratory examination revealed massive proteinuria (16.8 g/day) and severe hypoalbuminemia (1.2 g/dL). A renal biopsy revealed minimal change disease. She was treated with steroid pulse therapy and oral predonisolone (40 mg/day). She recovered completely 1 week after the steroid therapy. Throughout the course of her illness, no acute kidney injury or renal dysfunction were observed. Conclusion:Nephrotic syndrome is an extremely rare side effect when compared to the number of vaccinations; and it does not warrant witholding the vaccination as long as it is recognized that it is steroid-responsive.