Mazza Dayna, Ward Elizabeth, Makeneni Spandana, Zee Jarcy, Laskin Benjamin, Denburg Michelle
Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Nephrol. 2025 Apr 22. doi: 10.1007/s00467-025-06778-2.
Several case reports describe new onset or relapsed nephrotic syndrome (NS) after COVID-19 mRNA vaccination. However, there have been no systematic studies in children.
In this single-center, retrospective cohort study, we used our electronic health record registry to identify patients with NS who received ≥ 1 dose of COVID-19 vaccine from 12/2020 to 12/2022. For each patient, we determined number of relapses in the 180 days pre- and 60 days post-vaccination. Conditional logistic regression was used to assess risk of relapse after vaccination. Linear regression was used to estimate the mean difference between individual-level post- and pre-vaccine relapse rates.
Ninety-five patients with relapsing NS were included (median age 12 years, 43% female). Their clinical phenotype was as follows: 33% infrequent relapsing, 52% frequently relapsing (FR)/steroid-dependent (SD)/secondarily steroid responsive (SSR), and 16% steroid-resistant. Twenty-five patients (26%) relapsed in the pre-vaccine period, 17 (18%) had ≥ 1 relapse post-vaccination, and 78 (82%) had no relapse documented after COVID-19 vaccination. There was no significant difference in the risk of relapse after versus before vaccination (odds ratio 0.43, p = 0.08), and no significant difference in relapse rates after versus before vaccination (mean difference 0.08 per 100 patient-days, p = 0.39), overall or by phenotype. Of post-vaccine relapses, 94% occurred among the FR/SD/SSR group. Five patients met criteria for new onset NS presenting ≤ 60 days after receipt of the COVID-19 vaccine.
In a systematic pre/post comparison of individual-level relapse frequency, we found no significant difference in risk or rates of relapse after COVID-19 vaccination in children with NS.
几例病例报告描述了新型冠状病毒肺炎（COVID-19）信使核糖核酸（mRNA）疫苗接种后新发或复发的肾病综合征（NS）。然而，尚未对儿童进行系统研究。
在这项单中心回顾性队列研究中，我们利用电子健康记录登记系统，识别出2020年12月至2022年12月期间接受≥1剂COVID-19疫苗的NS患者。对于每名患者，我们确定了接种疫苗前180天和接种疫苗后60天内的复发次数。采用条件逻辑回归评估接种疫苗后复发的风险。采用线性回归估计个体水平接种疫苗后和接种疫苗前复发率的平均差异。
纳入95例复发性NS患者（中位年龄12岁，43%为女性）。其临床表型如下：33%为偶发性复发，52%为频繁复发（FR）/激素依赖型（SD）/继发性激素反应型（SSR），16%为激素抵抗型。25例患者（26%）在接种疫苗前复发，17例（18%）在接种疫苗后有≥1次复发，78例（82%）在COVID-19疫苗接种后无复发记录。接种疫苗后与接种疫苗前的复发风险无显著差异（比值比0.43，p = 0.08），接种疫苗后与接种疫苗前的复发率也无显著差异（平均差异为每100患者日0.08，p = 0.39），总体情况或按表型分析均如此。在接种疫苗后的复发中，94%发生在FR/SD/SSR组。5例患者符合在接种COVID-19疫苗后≤60天出现新发NS的标准。
在一项对个体水平复发频率进行的系统的接种前后比较中，我们发现NS患儿在接种COVID-19疫苗后的复发风险或复发率无显著差异。
