key: cord-0841760-bwa3jumu
authors: Morlidge, C.; El-Kateb, S.; Jeevaratnam, P.; Thompson, B.
title: Relapse of Minimal Change Disease Following the Astra-Zeneca COVID-19 Vaccine
date: 2021-06-10
journal: Kidney Int
DOI: 10.1016/j.kint.2021.06.005
sha: 9b8bb556f0ef89eccb6b4c75007098d75c9fb10f
doc_id: 841760
cord_uid: bwa3jumu

nan

A 30 year old man had received 1g of rituximab in August 2020 having experienced annual relapses on Tacrolimus. His prednisolone had been weaned to 1mg/day by January and discontinued altogether by February 2021. Two days post covid-19 vaccine he developed headache and frothy urine. Urine PCR one week later was 213; albumin preserved at 47g/l; creatinine stable at 82umol/L. At that time lymphocyte subsets showed complete B cell depletion, CD19 of 0.00. He did not seek medical attention until 2 months post vaccine when his urine PCR was 142mg/mmol. Repeat lymphocyte subsets then revealed B cell return, CD19 = 0.06. Complete remission was achieved with 10 days of starting prednisolone 20mg.

A 40 year old lady was maintained on prednisolone 5mg daily and tacrolimus ( Adoport), trough level 4.6ug/L before vaccination. One day post first covid-19 vaccine she developed headache, frothy urine and ankle swelling. After one week her general practitioner recorded 3+ dipstix proteinuria. Unfortunately no laboratory samples were sent. Prednisolone was increased to 30mg and complete remission was achieved within two weeks. Creatinine unchanged at 105mmol/L.

The association with various vaccines has been described, occurring between four days to several weeks later (1, 5, 6, 7) . The timing of Covid-19 vaccination and the very early development of relapse of MCD in our cases raises questions as to the mechanisms involved. At two days post vaccination one would assume the vaccine triggered a more generalised cytokine mediated response 7 . Others have postulated, symptoms after four days represent a rapid T-cell mediated response to viral mRNA 2,5,6 .

We administered the second dose of a different COVID vaccine and neither patient suffered adverse effect. However both patients were taking 15mg prednisolone at the time. This may prove a useful strategy in similar cases.

We await further reports to evaluate the true incidence.

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