COVID-19 vaccination and Atypical hemolytic uremic syndrome
IntroductionCOVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.Methods and ResultsHere we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days...
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| Format: | Article |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2022.1056153/full |
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| author | Romy N. Bouwmeester Esther M.G. Bormans Caroline Duineveld Arjan D. van Zuilen Anne-Els van de Logt Jack F.M. Wetzels Nicole C.A.J. van de Kar |
| author_facet | Romy N. Bouwmeester Esther M.G. Bormans Caroline Duineveld Arjan D. van Zuilen Anne-Els van de Logt Jack F.M. Wetzels Nicole C.A.J. van de Kar |
| author_sort | Romy N. Bouwmeester |
| collection | DOAJ |
| description | IntroductionCOVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.Methods and ResultsHere we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days (range 2-15) after mRNA-based (Pfizer/BioNTech’s, BNT162b2) or adenoviral (AstraZeneca, ChAdOx1 nCoV-19) COVID-19 vaccination. All three patients presented with evident hematological signs of TMA and AKI, and other aHUS triggering or explanatory events were absent. After eculizumab treatment, kidney function fully recovered in 2/3 patients. In addition, we describe two patients with dubious aHUS relapse after COVID-19 vaccination. To assess the risks of vaccination, we retrospectively evaluated 29 aHUS patients (n=8 with native kidneys) without complement-inhibitory treatment, who received a total of 73 COVID-19 vaccinations. None developed aHUS relapse after vaccination.ConclusionIn conclusion, aHUS should be included in the differential diagnosis of patients with vaccine-induced thrombocytopenia, especially if co-occuring with mechanical hemolytic anemia (MAHA) and acute kidney injury (AKI). Still, the overall risk is limited and we clearly advise continuation of COVID-19 vaccination in patients with a previous episode of aHUS, yet conditional upon clear patient instruction on how to recognize symptoms of recurrence. At last, we suggest monitoring serum creatinine (sCr), proteinuria, MAHA parameters, and blood pressure days after vaccination. |
| first_indexed | 2024-04-11T15:11:02Z |
| format | Article |
| id | doaj.art-d77bdd77ffaa46b19248ab2d98b4f6f6 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-11T15:11:02Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-d77bdd77ffaa46b19248ab2d98b4f6f62022-12-22T04:16:39ZengFrontiers Media S.A.Frontiers in Immunology1664-32242022-12-011310.3389/fimmu.2022.10561531056153COVID-19 vaccination and Atypical hemolytic uremic syndromeRomy N. Bouwmeester0Esther M.G. Bormans1Caroline Duineveld2Arjan D. van Zuilen3Anne-Els van de Logt4Jack F.M. Wetzels5Nicole C.A.J. van de Kar6Radboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, NetherlandsRadboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, NetherlandsRadboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, NetherlandsUniversity Medical Center Utrecht, Department of Nephrology and Hypertension, Utrecht, NetherlandsRadboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, NetherlandsRadboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, NetherlandsRadboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, NetherlandsIntroductionCOVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.Methods and ResultsHere we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days (range 2-15) after mRNA-based (Pfizer/BioNTech’s, BNT162b2) or adenoviral (AstraZeneca, ChAdOx1 nCoV-19) COVID-19 vaccination. All three patients presented with evident hematological signs of TMA and AKI, and other aHUS triggering or explanatory events were absent. After eculizumab treatment, kidney function fully recovered in 2/3 patients. In addition, we describe two patients with dubious aHUS relapse after COVID-19 vaccination. To assess the risks of vaccination, we retrospectively evaluated 29 aHUS patients (n=8 with native kidneys) without complement-inhibitory treatment, who received a total of 73 COVID-19 vaccinations. None developed aHUS relapse after vaccination.ConclusionIn conclusion, aHUS should be included in the differential diagnosis of patients with vaccine-induced thrombocytopenia, especially if co-occuring with mechanical hemolytic anemia (MAHA) and acute kidney injury (AKI). Still, the overall risk is limited and we clearly advise continuation of COVID-19 vaccination in patients with a previous episode of aHUS, yet conditional upon clear patient instruction on how to recognize symptoms of recurrence. At last, we suggest monitoring serum creatinine (sCr), proteinuria, MAHA parameters, and blood pressure days after vaccination.https://www.frontiersin.org/articles/10.3389/fimmu.2022.1056153/fullCOVID-19vaccinationatypical hemolitic uremic syndrometriggercomplementSARS-CoV-2 |
| spellingShingle | Romy N. Bouwmeester Esther M.G. Bormans Caroline Duineveld Arjan D. van Zuilen Anne-Els van de Logt Jack F.M. Wetzels Nicole C.A.J. van de Kar COVID-19 vaccination and Atypical hemolytic uremic syndrome Frontiers in Immunology COVID-19 vaccination atypical hemolitic uremic syndrome trigger complement SARS-CoV-2 |
| title | COVID-19 vaccination and Atypical hemolytic uremic syndrome |
| title_full | COVID-19 vaccination and Atypical hemolytic uremic syndrome |
| title_fullStr | COVID-19 vaccination and Atypical hemolytic uremic syndrome |
| title_full_unstemmed | COVID-19 vaccination and Atypical hemolytic uremic syndrome |
| title_short | COVID-19 vaccination and Atypical hemolytic uremic syndrome |
| title_sort | covid 19 vaccination and atypical hemolytic uremic syndrome |
| topic | COVID-19 vaccination atypical hemolitic uremic syndrome trigger complement SARS-CoV-2 |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2022.1056153/full |
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