A Case of Acute Interstitial Nephritis After Two Doses of the BNT162b2 SARS-CoV-2 Vaccine

Abstract

Background

The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine.

Case Presentation

We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient.

Conclusion

Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.

Keywords:

• acute kidney injury
• acute interstitial nephritis
• proteinuria
• COVID-19 vaccine

Abbreviations

AIN, Acute Interstitial Nephritis; AKI, acute kidney injury; ATN, Acute tubular necrosis; ANA, anti-nuclear antibodies; ANCA, antineutrophil cytoplasmic antibodies; BAT, Basophil Activation Test; HSR, hypersensitivity reaction; IFTA, Interstitial fibrosis and tubular atrophy; LTT, Lymphocyte Transformation Test; PEG, Polyethylene glycol.

Ethics Approval and Consent to Participate

Ethics committee approval was waived.

Consent for Publication

Written consent to publish this information was obtained from study participants.

Disclosure

Filipe S Mira and Jóni Costa Carvalho are co-first authors of this study. The authors declare that they have no competing interests.

Additional information

Funding

There is no funding to report.