Side effect of mRNA-based COVID-19 vaccination in renal: pros- and cons- in pathophysiological view on renal function

Abstract

Background: Several cases have been reported where mRNA-based COVID-19 vaccinations correlated with renal disease incidence in the form of minimal change disease (MCD) and immunoglobulin A nephropathy (IgAN) during renal biopsy investigation. However, this renal manifestation is not only detected in COVID-19 vaccination. Renal disease has been detected in other vaccinations such as influenza, pneumococcus, tetanus-diphtheria-poliomyelitis, and hepatitis B. However, the incidence was higher when the COVID-19 vaccination policy was carried out to minimalize the COVID-19's fatal effects and limit its spread. Objective: This viewpoint was written to describe the effect of mRNA COVID-19 vaccines on the renal area based on the scientific points of views in the nephrology field. Discussion: mRNA-based COVID-19 vaccination is carried out by lipid nanoparticles with the main target of activating T-cells as the adaptive immune response and inducing the innate immune system towards the virus via Toll-like receptors (TLR3 and TLR7). This leads to cellular activation and production of IFN type 1. mRNA-based COVID-19 vaccination in healthy adults produces an increment of IgA and IgG antigens. Further increments have been recorded after the second vaccination dose, and CD4+ T cells were stimulated towards Th1 to produce interferon-c (IFN-c), TNF-α, and IL-2. mRNA-based COVID-19 vaccination has been found to activate the immune function and trigger a flare of the disease, while others found that mRNA-based COVID-19 vaccines can re-activate autoantibody-mediated kidney disease. The pathophysiology of acute kidney injury (AKI) might be due to a secondary acute tubular necrosis because of the strong immune response. Conclusion: Although many kidney disease cases were reported during the mass COVID-19 vaccination policy, particularly in mRNA-based COVID-19 vaccination, this type of vaccine has been proven to be effective against COVID-19. There are more advantages to getting the vaccine than not. Moreover, the mechanism of renal disease after mRNA-based vaccination is unclear and debatable.