Abstract

Patients with kidney diseases have been prioritised for covid 19 vaccination due to their higher risk for worse outcomes from covid 19 infections. Data on vaccine efficacy and safety have generally been inferred from studies of non-CKD population. The immune response from vaccinations may trigger various diseases with an immunopathogenesis. We report a series of 3 patients with kidney diseases who developed adverse events worth noting following vaccination Case 1: 67 years old, Male, with underlying primary membranous nephropathy, treated with oral cyclophosphamide and steroids and was in partial remission with proteinuria of 1.1g/24H. He came with relapsed nephrotic range proteinuria of 5.3g/24H 2 weeks after the 1stdose of Pfizer–BioNTech COVID-19 vaccine. Anti- PLA2R titre repeated was 41.8 RU/ml from 1574 RU/ml. Proteinuria self-reduced to 1.6g/24H about 1 month post vaccination with conservative management. Case 2: 60 years old, male, with underlying ESRF on regular haemodialysis and diabetes mellitus, became acutely delirious with Glasgow Coma Scale (GCS) ranging 10 to 13, 3 days after 1stdose Sinovac CoronaVac covid-19 vaccine. Multiple investigations ruled out organic causes. Patient did not respond to empirical treatment of meningo-encephalitis but responded with intravenous methylprednisolone and recovered full GCS on day 2 of methylprednisolone. Cerebrospinal fluid was normal. MRI brain showed non-specific finding with focus T2W/ FLAIR hyperintensity at splenium of corpus callosum. Patient likely had Acute Disseminated Encephalomyelitis post- vaccination with rapid response to steroids. Case 3: 28 years old, female, with underlying Systemic Lupus Erythematosus (SLE) with renal, muco-cutaneous, and joint involvement had been in remission on maintenance therapy of Myfortic and low dose steroids; developed progressive generalised pustular lesions immediately day 3 post second dose Sinovac CoronaVac covid-19 vaccine. Skin biopsy done suggestive of acute generalised exanthematous pustulosis (AGEP). She had no history of concomitant medications, viral infections, or drug allergies either before or after the COVID-19 vaccination. Skin lesions improving with steroids and potassium permanganate wet dressing with emollients. Even though benefits from vaccination far outweighs potential risks, health professional should be alert to the various adverse events that may occur following covid-19 vaccination. Patients with kidney diseases may experience different adverse events post vaccination unique to their underlying kidney diseases. Further studies are needed for better understanding of the effects of vaccination in the CKD population.

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