TY - JOUR
T1 - COVID-19 vaccination and Atypical hemolytic uremic syndrome
AU - Bouwmeester, Romy N.
AU - Bormans, Esther M.G.
AU - Duineveld, Caroline
AU - van Zuilen, Arjan D.
AU - van de Logt, Anne Els
AU - Wetzels, Jack F.M.
AU - van de Kar, Nicole C.A.J.
N1 - Funding Information:
All prospective patients were included in the CUREiHUS study, which is supported by grants from Zorgverzekeraars Nederland and ZonMw, ‘Goed Gebruik Geneesmiddelen’ (project number 836031008). They did not have any role in data collection, analysis or submission of this manuscript.
Publisher Copyright:
Copyright © 2022 Bouwmeester, Bormans, Duineveld, van Zuilen, van de Logt, Wetzels and van de Kar.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - aHUS
KW - atypical hemolitic uremic syndrome
KW - complement
KW - COVID-19
KW - SARS-CoV-2
KW - thrombotic microagiopathy
KW - trigger
KW - vaccination
UR - http://www.scopus.com/inward/record.url?scp=85144120227&partnerID=8YFLogxK
U2 - 10.3389/fimmu.2022.1056153
DO - 10.3389/fimmu.2022.1056153
M3 - Article
C2 - 36531998
AN - SCOPUS:85144120227
SN - 1664-3224
VL - 13
SP - 1
EP - 8
JO - Frontiers in Immunology
JF - Frontiers in Immunology
M1 - 1056153
ER -