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editorial
. 2022 May 24;15(9):1643–1652. doi: 10.1093/ckj/sfac147

Table 1.

Cases of acute interstitial nephritis following SARS-CoV-2 vaccination reported in the literature as of 4 May 2022

Author/Country of case report Age (yrs) Sex Time to presentation from day of vaccination Significant co-morbidities New onset or relapse Vaccine brand Vaccine dose Baseline Creatinine (µmol/L) Presentation Creatinine (µmol/L) Kidney Biopsy Treatment Outcome
Choi J H et al./South Korea [45] 17 M 3 days New- onset Pfizer Second Not known 265 Interstitial infiltrates mainly mononuclear. Focal and moderate interstitial fibrosis and tubular atrophy in 20% of cortex. Negative IF. Findings consistent with AIN. Supportive care Discharged after 1 week
Choi J H et al./South Korea [45] 12 M 3 weeks New- onset Pfizer Second Not known 199 Tubules showed severe necrosis with heavy infiltration of neutrophils, eosino- phils and mononuclear cells in the interstitium. Slight foot process effacement. Oral steroids on day 10 of hospitalization Recovery of renal function
Czerlau et al./Switzerland [40] 55 M 4 days Hypertension, prostate cancer treated with prostatectomy New-onset Pfizer Second 76.5 355 Lymphocytes, plasma cells, macrophages, eosinophilic granulo-cytes and some neutrophilic granulo-cytes, tubulitis and interstitial oedema Steroid treatment—dose and length of treatment not specified Serum creatinine following treatment is 88 µmol/L
Czerlau et al./Switzerland [40] 54 M 3 days Myocardial infarction New-onset Moderna Second Not known 268 Lymphocytes, plasma cells, macrophages, and eosinophilic granulocytes, two granulomas, tubulitis + tubular destruction. Glomerular lesions in keeping with FSGS Steroid treatment—dose and length of treatment not specified Serum creatinine following treatment is 235 µmol/L
Czerlau et al./Switzerland [40] 58 M ‘A few days’ FSGS refractory to treatment, with multiple relapses New-onset Moderna Second 167 355 Lymphocytes, plasma cells, macrophages, with tubulitis and interstitial oedema Steroid treatment—dose and length of treatment not specified Serum creatinine following treatment is 210 µmol/L
Czerlau et al./Switzerland [40] 38 F 1 month Ulcerative colitis—received ustekinumab previously for treatment New-onset Moderna Second 76 86 Lymphocytes, plasma cells, macrophages, sporadic eosinophilic granulocytes and neutrophil granulo-cytes with tubulitis + interstitial oedema. EM shows mesangial IgA deposition. Steroid treatment—dose and length of treatment not specified Serum creatinine following treatment is 72 µmol/L
Czerlau et al./Switzerland [40] 35 F Exact time not specified Rheumatoid arthritis—on certolizumab treatment since 2016 New-onset Pfizer Second 49 100 Lymphocytes, plasma cells, macrophages, sporadic eosinophilic granulocytes and neutrophil granulo- cytes with tubulitis + interstitial oedema. EM shows mesangial IgA deposition. Steroid treatment—dose and length of treatment not specified Serum creatinine following treatment is 90 µmol/L
De la Flor et al./Spain [39] 78 M 3 weeks Hypertension, type 2 diabetes mellitus New-onset Pfizer First 150 475 Features of AIN along with glomerular sclerosis and other chronic changes IV MP followed by oral steroids Remained dialysis-dependent
Dheir H et al./Turkey [50] 44 F 48 hours New- onset Pfizer First Not known 186 Tubulointerstitial inflammatory infiltration containing eosinophils and lymphocytes and interstitial oedema Haemodialysis. Oral steroids 1 mg/kg Complete recovery of renal function
Fenoglio R et al./Italy [51] F 78 52 days Not stated New-onset Pfizer First Not stated Not stated Severe interstitial infiltration by mononuclear cells and polymorphonuclear leucocytes Dialysis. Oral steroids Dialysis discontinuation after 2 months
Fenoglio R et al./Italy [51] F 57 82 days Not stated New-onset Pfizer Second Not stated Not stated Severe interstitial infiltration by mono-nuclear cells and polymorphonuclear leukocytes. Oral steroids
Fenoglio R et al./Italy [51] F 65 24 days Not stated New-onset Oxford-AstraZeneca Second Not stated Not stated Severe interstitial infiltration by mononuclear cells and polymorphonuclear leucocytes Dialysis Oral steroids
Jongvilaikasem P and Rianthavorn P/Thailand [52] 14 M 5 days New onset Pfizer First Not known 177 Normal glomeruli with foot process effacement on EM. tubular injury and interstitial infiltrate IV MP followed by oral steroids. Haemodialysis for 3 weeks Improved creatinine to 47 µmol/L
Liew et al./United Kingdom [41] 53 M 3 days Hypertension New-onset Oxford-AstraZeneca Second Not known 1034 Morphologically normal glomeruli with interstitial oedema and infiltrate of lymphocytes, plasma cells and neutrophils with tubulitis Oral steroid treatment Improvement of renal function. Dialysis-independent following discharge
Mira F S et al./Portugal [53] 45 F 8 days Total thyroidectomy secondary to multinodular goitre New-onset Pfizer Second 75 1626 Mild interstitial infiltrate with oedema and acute tubular necrosis. 20% IFTA

Haemodialysis.

MTP 500 mg daily for 3 days, followed by 50 mg prednisolone

 Improvement of renal function- creatinine 168 µmol/L 4 days post discharge.
Rieckmann S et al./Germany [54] 63 M 3 weeks New-onset Pfizer First Normal range (not specified) 1679 Acute tubular necrosis, interstitial oedema and lymphoplasma-cellular interstitial infiltration with few eosinophil granulocytes

RRT on intensive care unit.

Oral steroids 250 mg for 3 days then reduced to 80 mg daily.

 Haemodialysis discontinued after 2 weeks.
Rieckmann S et al./Germany [54] 18 M 6 weeks New- onset Pfizer Second Not known 150

Lymphoplasma-cellular infiltration + eosinophil granulocytes and diffuse acute tubular necrosis.

Mesangial IgA

 Oral steroids 50 mg per day. Complete recovery of renal function within 2 weeks.
Rieckmann S et al./Germany [54] 25 F 3 weeks New-onset Pfizer Third Not known 1034 Severe, locally destructive interstitial nephritis with prominent diffuse acute tubular necrosis and slight eosinophilia Oral steroids 250 mg per day for 3 days then reduced to 80 mg daily Recovery of renal function within days.
Unver et al./Turkey [55] 67 F 3 weeks Type 2 diabetes mellitus. Recent new-onset minimal change disease following first dose of CoronaVac New-onset CoronaVac Second Not known (serum creatinine was 53 µmol/L) 371 Degeneration of proximal tubular cells and interstitial inflammation. Proteinaceous material was detected in many tubule lumens. Pulsed IV MP followed by oral steroids. Patient was then commenced on cyclosporine treatment Ongoing treatment. Proteinuria of 3g/day still apparent from last follow-up
Wu et al./United Kingdom [36] 69 F 5 days Rheumatoid arthritis, Sjøgren's syndrome, hypertension, hypothyroidism and anxiety New-onset Oxford-AstraZeneca First 85 245 Florid interstitial infiltrate with prominent eosinophils, with no glomerular abnormalities and no chronic interstitial damage Commenced on oral steroids. Discontinuation of regular medications such as ramipril, lansoprazole, methotrexate and paroxetine Improved serum creatinine to 130 µmol/L and resolved peripheral eosinophilia
Wu et al./United Kingdom [36] 60 F 2 weeks Hypertension New-onset Oxford-AstraZeneca Second 59 754 Widespread interstitial infiltrates in keeping with AIN Single dose IV pulsed MP followed by oral steroids. Full clinical recovery. Serum creatinine was 216 µmol/L in last follow-up review

AIN, acute interstitial nephritis; EM, electron microscopy; FSGS, focal segmental glomerulosclerosis; IF, immunofluorescence; IFTA, interstitial fibrosis and tubular atrophy; M, male; MCD, minimal change disease; MP, methylprednisolone; IgA, immunoglobulin A; IV, intravenous.