DOI: 10.12890/2026_006045

Acute kidney injury following vaccine-induced thrombotic microangiopathy

Authors

  • Mehnaz Aabideen Department of Nephrology and Kidney Transplantation, Burjeel Medical City, Abu Dhabi, United Arab Emirates; Peninsula Medical School, University of Plymouth, Plymouth, UK 0009-0003-8411-0994
  • Venkat Sainaresh Vellank Department of Nephrology and Kidney Transplantation, Burjeel Medical City, Abu Dhabi, United Arab Emirates
  • Mohammad Fahim Tungekar Uranologics Ltd, London, UK; Expressmed Laboratories, Zinj, Bahrain

snvellanki@yahoo.com

Keywords

COVID-19, mRNA vaccine, thrombotic microangiopathy, acute kidney injury, microvascular thrombosis

Abstract

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.

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References

  1. Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, et al. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024;42:2200–2211. doi: 10.1016/j.vaccine.2024.01.100
  2. Wolters-Kluwer. George JN, Chaturvedi S [Internet]. Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA): UpToDate. c2025 [Cited 16th August 2025]. Available from: https://www.uptodate.com/contents/virus-induced-immune-thrombotic-thrombocytopenia-vitt-and-vitt-like-disorders.
  3. Ma Q, Xu G. New-onset and relapsed thrombotic microangiopathy post-COVID-19 vaccination. J Med Virol 2023;95:e28946. doi:10.1002/jmv.28946
  4. Trougakos IP, Terpos E, Alexopoulos H, Politou M, Paraskevis D, Scorilas A, et al. Adverse effects of COVID-19 mRNA vaccines: the spike hypothesis. Trends Mol Med 2022;28:542–554. doi: 10.1016/j.molmed.2022.04.007
  5. Aigner C, Gaggl M, Schmidt S, Kain R, Kozakowski N, Oszwald A, et al. Complement-Mediated Thrombotic Microangiopathy Related to COVID-19 or SARS-CoV-2 Vaccination. Kidney Int Rep 2023;8:1506–1513. doi: 10.1016/j.ekir.2023.05.010
  6. Kaimori R, Nishida H, Uchida T, Tamura M, Kuroki K, Murata K, et al. Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report. Thromb J 2022;20:61. doi: 10.1186/s12959-022-00418-7
  7. John CV, Kumar R, Sivan AK, Jithin S, Abraham R, Philip CC. Vaccine-induced thrombotic thrombocytopenia (VITT): first report from India. Thromb J 2022;20:11. doi: 10.1186/s12959-022-00370-6
  8. Saluja P, Gautam N, Yadala S, Venkata AN. Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases. Thromb Res 2022;214:115–121. doi: 10.1016/j.thromres.2022.04.020
  9. Mohammad AM, Sgery ASH. Heterologous COVID-19 Vaccination; Sinopharm and Pfizer-BioNTech. Iraq Med J 2022;5:139–141. doi: 10.22317/imj.v5i4.1146
  10. Chang JC, Hawley HB. Vaccine-Associated Thrombocytopenia and Thrombosis: Venous Endotheliopathy Leading to Venous Combined Micro-Macrothrombosis. Medicina (Kaunas) 2021;57:1163. doi: 10.3390/medicina57111163

Published

2026-01-09

Issue

Vol. 13 No. 2 (2026)

Categories

How to Cite

1.
Aabideen M, Sainaresh Vellank V, Tungekar MF. Acute kidney injury following vaccine-induced thrombotic microangiopathy. EJCRIM [Internet]. 2026 Jan. 9 [cited 2026 Nov. 4];13(2). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6045