Acute kidney injury following vaccine-induced thrombotic microangiopathy

Background: Within 10 months of the declaration of the coronavirus disease 2019 (COVID-19) pandemic, multiple vaccines, including messenger ribonucleic acid, adenoviral vector, and inactivated vaccines, were developed. Adverse events associated with vaccination are closely monitored. Thrombotic microangiopathy after administration of the Pfizer/BioNTech BNT162b2 vaccine is a rare but serious adverse event. Case report: We report a 28-year-old healthy female who developed fever, arthralgias, myalgias, swelling of the feet, and bilateral loin pain 3 days after receiving the Pfizer/BioNTech BNT162b2 vaccine. She was diagnosed with acute kidney injury with raised creatinine and proteinuria. Kidney biopsy revealed a hilar thrombus, extensive glomerular basement membrane remodelling, and endothelial lesions attributed to vascular injury caused by the BNT162b2 vaccine. She responded well to conservative management and recovered fully from her renal failure. Conclusion: Our patient's favourable outcome of renal-limited thrombotic microangiopathy with little lasting effects is unique compared to other cases leading to end-stage renal disease or death. A high index of suspicion is needed for early diagnosis. The study of vaccine adverse effects is paramount to improve safety and confidence surrounding COVID-19 vaccination. LEARNING POINTS: Renal-limited thrombotic microangiopathy is a rare cause of acute kidney injury following vaccination.Renal recovery in renal-limited thrombotic microangiopathy is variable; conservative management with steroids is an initial option.Early comprehensive evaluation to exclude secondary causes of thrombotic microangiopathy, atypical haemolytic uremic syndrome, and autoimmune diseases is recommended.