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COVID-19 vaccination and Atypical hemolytic uremic syndrome.
Bouwmeester, Romy N; Bormans, Esther M G; Duineveld, Caroline; van Zuilen, Arjan D; van de Logt, Anne-Els; Wetzels, Jack F M; van de Kar, Nicole C A J.
  • Bouwmeester RN; Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands.
  • Bormans EMG; Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands.
  • Duineveld C; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands.
  • van Zuilen AD; University Medical Center Utrecht, Department of Nephrology and Hypertension, Utrecht, Netherlands.
  • van de Logt AE; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands.
  • Wetzels JFM; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands.
  • van de Kar NCAJ; Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands.
Front Immunol ; 13: 1056153, 2022.
Article in English | MEDLINE | ID: covidwho-2198898
ABSTRACT

Introduction:

COVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia. Methods and

Results:

Here 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.

Conclusion:

In 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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / Atypical Hemolytic Uremic Syndrome / COVID-19 Vaccines / COVID-19 / Anemia, Hemolytic Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Humans Language: English Journal: Front Immunol Year: 2022 Document Type: Article Affiliation country: Fimmu.2022.1056153

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / Atypical Hemolytic Uremic Syndrome / COVID-19 Vaccines / COVID-19 / Anemia, Hemolytic Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Humans Language: English Journal: Front Immunol Year: 2022 Document Type: Article Affiliation country: Fimmu.2022.1056153