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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Introduction:
There are several reports suggesting the involvement of SARS-CoV-2 (COVID-19) infection and COVID-19 messenger RNA (mRNA)-based vaccine respectively in the development and severity of nephrotic syndrome. Furthermore, some reports have assumed that mRNA-based vaccine-induced T cell activation and cytokine release may play a role in the development of nephrotic syndrome. We report a case of refractory nephrotic syndrome resulting in bilateral Achilles tendon rupture due to relapse by vaccination shortly after recovery from COVID-19.
Case Description
A 65-year-old man was diagnosed with minimal change nephrotic syndrome (MCNS) 37 years ago and was in remission with steroid therapy. Although it recurred a total of five times over the next 36 years, the disease remained relatively stable, Two months before admission, he developed a COVID-19 pneumonia and was cured by treatment. Just two months later, he received the third dose of COVID-19 vaccine and was admitted to our department with generalized edema, rapid weight gain of 12 kg in 2 weeks, proteinuria (3.3 g/gCr) and hypoalbuminemia (2.9 mg/dL). After admission, steroid pulse therapy was started, and renal biopsy revealed MCNS recurrence. The patient was treated with steroid pulse therapy for three times followed by combination therapy with oral prednisolone, cyclosporine A and low density lipoprotein (LDL) apheresis, but the response was poor. Eight months after relapse, rituximab therapy was started. Although proteinuria gradually decreased, gait disturbance appeared and bilateral Achilles tendon ruptures were discovered.
Discussion
Although there have been scattered reports suggesting that COVID-19 infection and COVID-19 vaccine respectively have been implicated in the development and severity of nephrotic syndromes, including MCNS, the precise mechanism is not fully understood. Previous reports indicate that most cases show relatively good response to treatments such as steroid for nephrotic syndrome that recurred after vaccination, whereas this case demonstrated poor response to methylprednisolone, CyA, and LDL apheresis and was extremely difficult to treat. In this case, it is speculated that the vaccination shortly after recovery from COVID-19 acted as a booster, leading to abnormal activation of the immune system and worsened treatment response. Furthermore, it is assumed that the marked improvement in general condition and the start of walking led to sudden mechanical stress, triggering bilateral Achilles tendon rupture. As far as we could search, there were no reports of bilateral Achilles tendon rupture during treatment for nephrotic syndrome, so we considered this case to be extremely rare.
