Minimal change nephrotic syndrome in an 82 year old patient following a tetanus-diphteria-poliomyelitis-vaccination.
BACKGROUND
The most common cause of idiopathic nephrotic syndrome in children and younger adults is the minimal change nephrotic syndrome (MCNS). In the elderly MCNS is relatively uncommon. Over the last decade some reports suggest a rare but possible association with the administration of various vaccines.


METHODS
A 82-year old Caucasian female presented with pronounced nephrotic syndrome (proteinuria of 7.1 g/d, hypoproteinemia of 47 g/l). About six weeks prior to admission, she had received a combination vaccination for tetanus, diphtheria and poliomyelitis as a booster-vaccination from her general practitioner. The renal biopsy revealed typical minimal change lesions. She responded well to the initiated steroid treatment. As through physical examination as well as extensive laboratory and imaging studies did neither find any evidence for malignancies nor infections we suggest that the minimal change nephrotic syndrome in this patient might be related to the activation of the immune system triggered by the vaccination.


CONCLUSIONS
Our case as well as previous anecdotal reports suggests that vaccination and the resulting stimulations of the immune system might cause MCNS and other severe immune-reactions. Increased awareness in that regard might help to expand the database of those cases.
Clajus
Christian
C
Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany. clajus.christian@mh-hannover.de
Spiegel
Janine
J
Bröcker
Verena
V
Chatzikyrkou
Christos
C
Kielstein
Jan T
JT
D000369:Aged, 80 and over; D004168:Diphtheria Toxoid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009402:Nephrosis, Lipoid / Q000139:chemically induced* / Q000517:prevention & control*; D011054:Poliovirus Vaccine, Inactivated / Q000009:adverse effects*; D011055:Poliovirus Vaccine, Oral; D013745:Tetanus Toxoid / Q000009:adverse effects*; D017778:Vaccines, Combined / Q000009:adverse effects
D004168:Diphtheria Toxoid; D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral; D013745:Tetanus Toxoid; D017778:Vaccines, Combined