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

Figures & data

Table 1 Initial Laboratory Results

Blood Tests on Arrival		Normal Values
Hemoglobin (g/dL)	10.1	12.5–17.5
Leukocytes (10^9/L)	8.5	4.0–10.0
Platelets (10^3/L)	391	150–400
Serum creatinine (mg/dL)	18.4	0.5–0.9
Serum sodium (mmol/L)	134	136–145
Serum potassium (mmol/L)	5.7	3.5–5.1
Lactate dehydrogenase (U/L)	410	125–220
C reactive protein (mg/dL)	1.8	0–0.5
Serum albumin (g/dL)	3.1	3.5–4.5

Table 2 Full Immune Evaluation and Specific Tests

Additional Blood and Urine Tests Performed
Protein electrophoresis	Normal
Immunofixation	Normal
Ratio of kappa and lambda light chains	1.7mg/L (N = 0.37–3.1mg/L)
C3	0.89g/L (N = 0.83–1.93 g/L)
C4	0.3 g/L (N = 0.15–0.57 g/L)
Antinuclear antibodies	Negative
Anti-dsDNA	1.7IU/mL (N < 10IU/mL)
Anti C and P ANCA antibodies	Negative
Cryoglobulins	Negative
Hepatitis B, C and HIV screening	Negative
24 hour urine collection proteinuria	531 mg
Urinalysis	Protein 100 mg/dL; Hemoglobin 0.2 mg/dL; Leukocytes 500 cel/uL with both leukocytes and erythrocytes on the sediment

Figure 1 Kidney biopsy findings. (A) the glomerular compartment is unremarkable: normal capillary wall and no mesangial or endocapillary hypercellularity, renal cortex with inflammation ((A) periodic acid-Schiff stain, original magnification, 200x; (B) electron microscopy exhibiting podocyte focal foot process effacement without changes to the glomerular basement membrane; (C) renal cortex exhibiting mild interstitial edema and inflammation as well as acute tubular injury. (H&E stain, original magnification, 100x); (D) normal capillary walls without mesangial or endocapillary hypercellularity (Jones methenamine silver stain, original magnification, 200x).