Acute interstitial nephritis after vaccination with BNT162b2

Excerpt

A 63-year-old male without any medical history was admitted to hospital because of malaise and anuria 3 weeks after his first vaccination with BNT162b2. The laboratory findings revealed acute kidney injury with an initial serum creatinine concentration of 19.0 mg/dl, metabolic acidosis and hyperkalemia of 9 mmol/l. Urinalysis showed nitrite negative leukocyturia, hematuria and proteinuria (albumin-to-creatinine ratio (ACR) 393 mg/g, protein-to-creatinine ratio (PCR) 787 mg/g). Serum creatinine concentration was in the normal range at his most recent laboratory examination. We performed a kidney biopsy, which revealed acute interstitial nephritis (AIN, Fig. 1A, B) with interstitial edema, lymphoplasmacellular interstitial infiltration with eosinophil granulocytes, and acute tubular necrosis. The patient denied having taken any medication. Anti-neutrophil antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), IgG4, angiotensin-converting enzyme (ACE) and soluble IL2 receptor (sIL2R), immunofixation and hantavirus serology were unremarkable. RT-PCR from a nasopharyngeal swab specimen was negative for SARS-CoV-2. The patient denied any symptoms of COVID-19 in the past months. Thus, the SARS-CoV-2 vaccination was the only apparent trigger of the interstitial nephritis with acute kidney injury AKIN stage III. Initially, the patient required renal replacement therapy at an intensive care unit. Anti-inflammatory therapy was started with a daily dosage of 250 mg prednisolone and was deescalated to a daily dosage of 80 mg after three days. Diuresis > 500 ml returned after 8 days, and hemodialysis was successfully discontinued after 2 weeks.

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