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INTRODUCTION
The mRNA vaccines have demonstrated effectiveness against SARS-CoV-2 infection diminishing significantly mortality and incidence of severe cases. Among the side effects of these vaccines, the development of minimal change disease (MCD) has been reported worldwide as case reports.
OBJECTIVE
To describe a case of MCD and the possible association to vaccination against COVID-19.
CASE REPORT
A 58-year-old man, previously healthy man, two weeks prior to his admission had received a second dose of vaccination against SARS-CoV-2 (Pfizer-BNT162B1). He was admitted for progressive and symmetrical edema in the lower extremities of two weeks of evolution. On admission physical examination showed blood pressure 144/80mmHg and anasarca. Laboratory tests: creatinine 3.31mg/dL, hypoalbuminemia 1.8g/dL, hypercholesterolemia 385mg/dL, a proteinuria-creatinuria index of 7.8g/g in 24-hour urine collection. Hepatitis B surface antigen, antibodies to Hepatitis C and HIV fourth generation ELISA gave negative results; tests for antineutrophil cytoplasmic antibody (ANCA), anti-glomerular basement membrane (GBM) antibodies and antinuclear antibody (ANA) also gave negative; levels of complement C3 and C4 were normal according to the reference ranges. Renal ultrasound showed no alterations. Tumor markers were requested and a contrasted CT scan was performed without evidence of masses or lesions suggestive of malignancy. During hospitalization he required renal replacement therapy due to water overload refractory to medical treatment. Renal biopsy showed glomerular changes suggestive of podocytopathy without sclerosis, with main characteristics of minimal change disease.
DISCUSSION
Few cases of immune-mediated reactions have been reported such as glomerulonephritis (GN). In this case, the main causes of MCD in adulthood were ruled out: infectious, autoimmune, acquired and neoplasic causes. The association between vaccination for COVID-19 and the occurrence of MCD is evident. However, the pathophysiology is unclear, leaving in doubt whether it is due to the immune response generated by the vaccine or to the inflammatory response against SARS-CoV-2 infection. It is necessary to further study the MCD association to vaccination against Covid-19, also to evaluate the prevalence and incidence of this adverse event and possible triggering factors that still unknown.
Conclusions
CONCLUSIONS
This is a potential adverse effect that should be considered in patients who have been vaccinated in the past weeks and develop nephrotic syndrome. Given the low incidence of its presentation and the benefit that vaccination provides to the population, it is recommended to continue with vaccination worldwide.