Acute Kidney Injury Following Vaccine-Induced Thrombotic Microangiopathy

Area of Science:

• Nephrology
• Immunology
• Vaccinology

Background:

• The COVID-19 pandemic spurred rapid vaccine development, including mRNA vaccines like Pfizer-BioNTech BNT162b2.
• Monitoring vaccine adverse events is crucial for public safety and vaccine confidence.
• Thrombotic microangiopathy (TMA) is a rare but serious adverse event associated with the BNT162b2 vaccine.

Purpose of the Study:

• To report a case of renal-limited TMA following BNT162b2 vaccination.
• To highlight the clinical presentation, diagnostic findings, and management of vaccine-associated TMA.
• To emphasize the importance of early diagnosis and monitoring of rare vaccine adverse events.

Main Methods:

• A case report of a 28-year-old female presenting with symptoms 3 days post-BNT162b2 vaccination.
• Clinical evaluation including laboratory tests (creatinine, proteinuria) and kidney biopsy.
• Assessment of treatment response to conservative management.

Main Results:

• The patient developed acute kidney injury with proteinuria and was diagnosed with renal-limited TMA.
• Kidney biopsy confirmed hilar thrombus, glomerular basement membrane remodeling, and endothelial lesions.
• The patient responded well to conservative management and achieved full renal recovery.

Conclusions:

• Renal-limited TMA is a rare cause of acute kidney injury post-vaccination.
• Conservative management, potentially including steroids, is a viable initial approach for renal recovery in TMA.
• Prompt evaluation to rule out secondary causes of TMA is recommended.