Early nephrotic syndrome after vaccination for SARSCoV-2 with Pfizer - BioNTech in a patient with bisalbuminemia

Abstract

Background: Nephrotic syndrome (NS) is a clinical syndrome defined by massive proteinuria greater than 3.5 g/24h, responsible for hypoalbuminemia (less than 30 g/L), with resulting hyperlipidemia, edema, and various complications. It is caused by increased permeability through the damaged basement membrane in the renal glomerulus. Etiologies include primary and secondary causes, among which are systemic, metabolic, genetic, infectious, neoplastic, and pharmacological diseases. Among the complications to be considered, the state of hypercoagulability, susceptibility to infections, and an increase in cardiovascular risk should be highlighted. Case presentation: A 69-year-old female patient, without any relevant pathological history, consulted due to a clinical that began a week after the application of the Pfizer-BioNTech vaccine that generated progressive edema of the lower limbs with the first dose and later until anasarca after receiving the second dose. Among the requested paraclinical tests, proteinuria in the nephrotic range, hypoalbuminemia, and hyperlipidemia were obtained. Infectious and autoimmune causes were ruled out, and protein electrophoresis was requested in which bisalbuminemia with distortion in the gamma zone was reported. Renal biopsy reports endocapillary glomerulonephritis. Conclusions: The etiology of nephrotic syndrome is diverse, various systemic, infectious, and neoplastic pathologies must be ruled out. The reported case shows that this happens early after the application of the Pfizer-BioNTech vaccine. It is important to report that it occurs in the context of bisalbuminemia, which is not triggered by nephrotic syndromebutisobservedwithsomedegreeoffrequency in these patients.