Post vaccination acute kidney injury and other renal complications after COVID-19 and influenza vaccination

Table 2 Population-level renal outcomes reported following coronavirus disease 2019 vaccination¹

Ref.	Type of vaccine	Associated kidney injury	Incidence
Wan et al[13], 2022; Yechezkel et al[14], 2023; Lee et al[56], 2022; Kim et al[57], 2022; Kim et al[58], 2022; Kim et al[59], 2023; Luo et al[60], 2022; Hwang et al[61], 2025; Yan et al[62], 2022; Yoon et al[63], 2023	mRNA vaccine	Unspecified acute kidney injury (AKI)	1.17/100000 doses (0.21, 3.41), 2.21/100000 persons (0.46, 6.46), and the incidence rate was 20.94/100000 person-years (6.75, 64.92); The risk difference reported after the second booster is 1.68/100000 people (-3.37 to 6.74), and risk difference of second boosters vs first boosters is 3.93/100000 (-0.56 to 8.42) although both results were found to be not statistically significant; 17 cases of AKI out of 153183 adverse events; 4 cases/100000 people for 12-17 years old, 4 cases/100000 for 5-17 years old; 0.1/100000 persons incidence of AKI for 18 years old and above; Pfizer: AKI reporting odds ratio (ROR) of 2.15 (1.97, 2.36), proportional reporting ratio (PRR) of 2.15 (χ2 = 290.75), and an Information component (IC) of 0.9 (IC025 = 0.82), Empirical Bayes Geometric Mean (EBGM) of 1.87 (EBGM05 = 1.73); Moderna: AKI ROR of 1.25 (1.13-1.39), PRR of 1.25 (χ2 =17.97) and IC of 0.27 (IC025 = 0.24) and a EBGM of 1.21 (EBGM05 = 1.11); disproportionate signal of AKI with ROR of 2.38 (2.30-2.46) and IC of 1.14 (IC025 = 1.09); BNT162b2 mRNA: AKI ROR of 5.41 (4.54-6.43); mRNA-1273: AKI ROR of 2.48 (2.05, 3.00); In a Vigibase analysis of the WHO pharmacovigilance database, COVID-19 mRNA vaccines were solely associated with higher reporting of AKI (IC025 = 1.09) and tubular interstitial nephritis (TIN) (IC025 = 0.48) compared to other types of vaccines
Waldman et al[11], 2023; Diebold et al[20], 2022; Kronbichler et al[64], 2022		Minimal change disease (MCD)	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 28.6% (28/98) of patients presented with MCD, with 75% of MCD due to mRNA vaccines; risk ratio between MCD and COVID-19 vaccine is 1.72 (95%CI: 0.46-6.38); MCD after Pfizer/BioNTech mRNA vaccine: IC/IC025 of 0.88/0.37 with 36 cases out of 770304 individual case safety reports (ICSR) reported
Kamei et al[10], 2023; Mazza et al[28], 2023; Kronbichler et al[64], 2022		Unspecified nephrotic syndrome	In 40 patients with childhood-onset nephrotic syndrome using immunosuppressive agents, 3 (7.5%) patients suffered from a relapse of nephrotic syndrome (2 and 3 days after the first dose and 8 days after 2nd dose), and 2 patients suffered from transient proteinuria after COVID-19 vaccination; in 95 patients with relapsing nephrotic syndrome, 17 (18%) patients had ≥ 1 relapse post vaccination, with no significant difference in the risk of relapse after vs before vaccination (odds ratio = 0.43, P-value = 0.08), and no significant difference in relapse rates after vs before vaccination (mean difference 008 per 100 patient-days, P-value = 0.39); 5 patients had new onset nephrotic syndrome presenting within 60 days of taking the vaccine; nephrotic syndrome after Pfizer/BioNTech mRNA vaccine: IC/IC025 of 0.60/0.31 with 103 cases out of 770304 ICSRs
Waldman et al[11], 2023; Diebold et al[20], 2022; Ota et al[22], 2023; Kronbichler et al[64], 2022; Aoki et al[65], 2023; Poster Abstracts[66], 2022; Nakao et al[67], 2023		IgA nephropathy	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID vaccine, 26.5% (26/98) of patients presented with IgA nephropathy, with 73.1% of IgA Nephropathy due to mRNA vaccines, with most patients (38.5%) presenting within 1-2 days after the vaccine; in a retrospective cohort study using a cohort representing the entire adult Swiss population, they found the risk ratio between IgA nephropathy to COVID-19 vaccine = 1.14 (95%CI: 0.67-1.97); in IgA nephropathy histopathology, acute lesions were found to be associated with renal events, and E lesions were associated with worsening haematuria; IgA nephropathy after moderna vaccine: IC/IC025 of 1.51/0.71 with 19 out of 286467 ICSRs; in 82 patients who presented with gross haematuria after COVID-19 vaccination, 42 patients have a new diagnosis of IgA nephropathy (n = 41); in an analysis of 20 cases of post-vaccine IgA nephropathy, the mean time to onset was 3.18 days (1-31 days), where 60% of the cases came from COMIRNATY vaccine, and 40% came from SPIKEVAX; additionally, the study found that macroscopic haematuria was the most revealing symptom, and 35% of patients in the study had AKI; ROR of IgA nephropathy to COVID-19 mRNA vaccines is 6.49, 95%CI: 4.38-9.61, IC of 2.27, 95%CI: 1.70-2.83), showing a significant increase in reported number from baseline after COVID-19 vaccine; time to onset of IgA nephropathy from vaccine is 2 patients on the same day, 5 patients 1 day later, 4 patients 2 days later, 3 patients 3-28 days later and 2 patients more than 28 days later
Aoki et al[65], 2023		IgA nephropathy relapse	22 out of 82 patients who presented with gross haematuria after COVID-19 vaccination had a prior diagnosis of IgA nephropathy or IgA vasculitis
Aoki et al[65], 2023		IgA vasculitis	42 out of 82 patients who presented with gross haematuria after COVID-19 vaccination have a new diagnosis of IgA vasculitis
Aoki et al[65], 2023		IgA vasculitis relapse	22 out of 82 patients who presented with gross haematuria after COVID-19 vaccination had a prior diagnosis of IgA nephropathy or IgA vasculitis
Thepveera et al[29], 2025		Lupus nephritis	Out of 69 vaccinated adolescents with SLE; 24 (34.8%) experienced SLE flares; 14 (20.3%) out of the 69 patients experienced a new or worsened renal flare, including 13 (27.7%) of 47 patients who have had previous lupus nephritis; 5 (7.2%) renal flares occurred within the first month, 1 (1.4%), 4 (5.8%) and 4 (5.8%) patients at the 3-, 6- and 12-month follow-ups, respectively; 4 (8.7%) out of 46 of the patients had their renal flares occurred after they were administered the third vaccine dose; manifestations of renal flares include increased proteinuria (71.4%), abnormal urine sediment (42.9%) and decreased renal function (28.6%)
Waldman et al[11], 2023; Diebold et al[20], 2022		Membranous nephropathy	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 10.2% (10/98) of patients presented with membranous nephropathy, with 80% of membranous nephropathy due to mRNA vaccines, with most patients (30%) presenting within 5-7 days after vaccine; risk ratio between membranous nephropathy to COVID-19 vaccine = 1.17 (95%CI: 0.43-3.23)
Waldman et al[11], 2023; Diebold et al[20], 2022		Crescentic glomerulonephritis: Pauci-immune	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 17.3% (17/98) of patients presented with pauci-immune crescentic glomerulonephritis, with 94.1% due to mRNA vaccines, with most patients (35.3%) presenting 2 weeks after the vaccine; risk ratio between pauci-immune necrotising glomerulonephritis and COVID-19 vaccine = 0.54 (95%CI: 0.26-1.15)
Waldman et al[11], 2023		Crescentic glomerulonephritis: Anti-GBM	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 5.1% (5/98) of patients presented with anti-GBM, with 40% of MCD due to mRNA vaccines, with most patients (60%) presenting 2 weeks after vaccine
Ota et al[22], 2023; Hwang et al[61], 2025		Unspecified glomerulonephritis	Out of 111 adults with diagnosed glomerulonephritis, 22.5% developed a renal event (increased proteinuria, haematuria or 1.5x increase in serum creatinine) post 2 doses of COVID-19 vaccination, with only 0.9% requiring temporary haemodialysis and 1.8% requiring additional immunosuppressive treatment; ROR of 13.41 (12.62-14.26) and IC of 2.98 (IC025 = 2.90)
Hwang et al[61], 2025		Acute tubulointerstitial nephritis	ROR of 2.43(2.11-2.81) and IC of 1.22 (IC025 = 0.99)
Lee et al[68], 2023		Immune thrombotic thrombocytopenic purpura leading to AKI	ROR of 0.81 (0.79-0.83) and IC: -0.28 (IC025: -0.31)
Wan et al[13], 2022		Rhabdomyolysis leading to AKI	Incidence of 0.75/100000 doses (0.09, 2.71); 1.42/100000 persons (0.17, 5.13), and the incidence rate was 13.48/100000 person-years (3.37, 53.88)
Sanders et al[12], 2022; HK et al[17], 2022		Renal transplant rejection or pathological change	1 out of 159 patients faced kidney transplant rejection; 40.1% of kidney transplant recipients showed a rise in creatinine, proteinuria, or new microscopic haematuria
Lee et al[56], 2022; Luo et al[60], 2022	Vector vaccine	Unspecified AKI	Out of 153183 adverse events following COVID-19 vaccination, 62 cases of AKI were reported in patients who took AZD1222 vaccines and 6 cases in patients who took JNJ-78436735; ROR of AKI and Jannsen: ROR of 1.04 (0.84, 1.28), PRR of 1.04 (χ2 = 0.12), and an IC of 0.5 (IC025 = 0.04), EBGM of 1.04 (EBGM05 = 0.87)
Waldman et al[11], 2023		MCD	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 28.6% (28/98) of patients presented with MCD, with 14.3% of MCD due to Vector vaccines, with most patients (35.7%) presenting within 5-7 days after the vaccine
Waldman et al[11], 2023		Crescentic glomerulonephritis pauci-immune	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 17.3% (17/98) of patients presented with pauci-immune crescentic glomerulonephritis, with 5.9% due to Vector vaccines, with most patients (35.3%) presenting 2 weeks after the vaccine
Waldman et al[11], 2023		Collapsing glomerulopathy	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 5.1% (5/98) of patients presented with collapsing glomerulonephritis, with 20% of collapsing glomerulonephritis due to Vector vaccines, with most patients (60%) presenting within 5-7 days after the vaccine
Hwang et al[61], 2025		Unspecified glomerulonephritis	Disproportionate signal with ROR of 3.12 (2.73-3.56) and IC of 1.58 (IC025 = 1.36)
Lee et al[68], 2024		Thrombotic thrombocytopenia leading to AKI	ROR of 1.64 (1.59-1.68) and IC: 0.69 (IC025: 0.64)
Wan et al[13], 2022	Inactivated vaccine	Unspecified AKI	Incidence for AKI post CoronaVac inactivated vaccine was 1.41/100000 doses (0.46, 3.28), 2.51/100000 persons (0.81, 5.85), and the incidence rate was 25.42/100000 person-years (10.58, 61.08)
Zhang et al[27], 2024		Membranous nephropathy	No difference in the rate of relapse or worsening between the two groups, with 10 (13%) in the vaccinated group and 11 (15%) in the unvaccinated group (hazard ratio = 0.98, 95%CI: 042-2.33)
Waldman et al[11], 2023		Anti-GBM disease	In a retrospective cohort study that included subjects with de novo glomerulonephritis presenting 3 months after the COVID-19 vaccine, 5.1% (5/98) of patients presented with anti-GBM, with 60% of MCD due to inactivated vaccines, with most patients (60%) presenting 2 weeks after the vaccine
Song et al[69], 2023	Recombinant protein nanoparticle vaccine	AKI, rapidly proliferative glomerulonephritis, cutaneous vasculitis	3 cases of systemic adverse events were reported in the GBP510 group, with the cases being AKI, rapidly progressive glomerulonephritis and cutaneous vasculitis
Choi et al[15], 2024; Lionaki et al[16], 2024; Chen et al[19], 2023; Aoki et al[26], 2024; Tsai et al[30], 2025; Abdel-Qader et al[70], 2022; Hu et al[71], 2024; Nurminen et al[72], 2025; Lichtbroun et al[73], 2024; Anastassopoulo et al[74], 2023; Cullen et al[75], 2023; Tavakoli et al[76], 2021	Unspecified vaccine	Unspecified AKI	Absolute risk difference for AKI per 100000 persons was reported as 0.06, with the incidence rate ratio reported as 0.67 (0.11-3.99), and hence it was not statistically significant; 23 out of 255 patients (9%) experienced a glomerular disease relapse after vaccination, with the average time to relapse from vaccination being 2.5 months; 27 cases out of 1897 COVID-vaccinated adults were found to develop COVID-19 vaccine related acute kidney disease; in a study of patients presenting with gross haematuria after the COVID-19 vaccine, none of the patients in the cohort developeda 15-fold increase in serum creatinine from baseline, proteinuria also only temporarily increased after the vaccinations; out of 127 patients who presented with gross haematuria, 37 patients had kidney biopsy done before where 35 patients were previously diagnosed with IgA nephropathy, 1 patient with IgA vasculitis and one patient with proliferative glomerulonephritis with monoclonal IgG deposits; out of the 90 patients who did not have prior kidney biopsy, 70 patients went for post-gross haematuria biopsy, with 67 of them being diagnosed with IgA nephropathy, 2 of them diagnosed with IgA vasculitis and 1 patient with non-IgA proliferative glomerulonephritis using the biopsy; 71% of these patients have had pre-vaccination abnormal urinary findings; COVID-19 is hypothesised to have manifested the subclinical IgA nephropathy; vaccinated individuals were found to have a higher incidence of AKI (HR = 1.20, 95%CI: 1.18-1.23) and dialysis initiation (HR = 1.84, 95%CI: 1.68-2.01) compared with unvaccinated individuals; at one year of follow-up, there were 7693 deaths in the vaccinated group and 7364 deaths in the unvaccinated group; mortality risk was significantly lower among vaccinated individuals (HR = 0.88, 95%CI: 0.85-0.91); cumulative incidence curves demonstrated higher rates of AKI and dialysis in the vaccinated cohort, whereas the probability of death was significantly lower in vaccinated compared with unvaccinated individuals (P-value < 0.001); in a prospective observational study in Jordan, 129 AKI events were reported after the COVID-19 vaccine; with 19.7 events/100000 persons reported in the study; in a Taiwanese VAERS analysis, there were 12 cases of AKI reported after COVID vaccine with the time of onset falling between 1-70 days; renal failure is reported in 13 cases out of 456 COVID-19 vaccine related adverse drug reaction reports with fatal outcomes; 12 cases were associated with cominarty vaccine and 1 case associated with Spikevax vaccine; there were 1572 cases of Haematuria were reported in a VAERS study with 13568650 COVID-19 vaccine associated symptoms reported, with the adverse event rate of haematuria being (0.012%); overall reporting rate for AKI post COVID-19 vaccine was 3.03 reports per 1 million doses and the reporting rate of renal failure post COVID-19 vaccine was 1.11 reports per million doses; potential side effects were elevated following vectored vaccines rather than mRNA vaccines (RR of AKI post AD26.COV2.S vaccine is 12.24, 95%CI: 10.66-13.81; while the reporting rate of renal failure post AD26.COV2.S vaccine is 3.17 95%CI: 2.36-3.97); there were 1312 deaths possibly associated with AKI (RR = 0.94, 95%CI: 0.89-0.99) and 460 deaths possibly associated with renal failure (RR = 0.33, 95%CI: 0.30-0.36) per million vaccine doses; the odds of a ≥ 65 years male reporting AKI post COVID vaccine is 7.23 times (95%CI: 6.63-7.88, P-value = 0.000) compared to 18-64 years old; the odds of a ≥ 65-year-old male reporting renal failure post COVID vaccine is 4.74 times (95%CI: 3.99-5.63, P-value < 0.001) compared to 18-64 years old; IR of acute renal failure during the pandemic period [449.8 (CI: 442.9-456.7)] was lower than the pre-pandemic period [478.4 (CI: 475.8-481)]; 8 cases of renal side effects (0.0007% of the targeted population), with 4 cases being proteinuria, 2 cases being haematuria and 2 being renal dysfunction
Huang et al[31], 2025		Safety in chronic kidney disease	Vaccinated cohort demonstrated a significantly reduced risk of major adverse kidney events or death (HR = 0.637, 95%CI: 0.581-0.689), major adverse kidney events alone (HR = 0.792, 95%CI: 0.698-0.898), and all-cause mortality (HR = 0.549, 95%CI: 0.484-0.622)
Lionaki et al[16], 2024; Carrillo et al[18], 2023; Canney et al[21], 2022		MCD	6 patients out of 29 patients experienced a relapse of MCD after COVID-19 vaccination; the incidence of MCD was significantly higher post-Spanish vaccine (n = 20) (COVID-19 vaccine) than pre-Spanish vaccine (n = 13) (P-value=0.002); absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 1% to 2% in those with MCD
Lionaki et al[16], 2024; Carrillo et al[18], 2023		Focal segmental glomerulosclerosis (FSGS)	2 out of 38 patients experienced a relapse of focal segmental glomerulosclerosis after COVID-19 vaccination; the absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 1% to 2% in those with focal segmental glomerulosclerosis
Carrillo et al[18], 2023		Idiopathic nephrotic syndrome	In a retrospective observational cohort study, the incidence of idiopathic nephrotic syndrome was significantly higher post-Spanish vaccine (n = 18,10.7%) (COVID-19 vaccine) than pre-Spanish vaccine (n = 11, 5%) (P-value =0.036)
Lionaki et al[16], 2024; Canney et al[21], 2022		IgA nephropathy	7 patients out of 41 patients experienced a relapse of IgA nephropathy after COVID-19 vaccination; the absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 3% to 5% in those with IgA nephritis
Sun et al[24], 2024; Nagatsuji et al[25], 2024		IgA nephropathy relapse	Significant decrease in eGFR in IgA nephropathy patients with 30 ≤ eGFR < 60 post second dose (n = 18, P = 0.01); however, there was a trend towards a decrease in eGFR after 6-month follow-up in vaccinated patients, although this difference was not significant (P = 0.06); the study also reported that there were 10 patients who displayed worsening proteinuria post vaccination; no significant changes in renal function or proteinuria before vs after vaccination in patients with gross haematuria, however, evaluation of the rate of change in eGFR showed that three of 16 patients with gross haematuria had an eGFR decrease of more than 10% after approximately 1 year; in addition, in four of the patients, renal biopsy was performed and showed Crescent formation in the glomerulus in three of the patients
Lionaki et al[16], 2024; Canney et al[21], 2022; Kim et al[77], 2024		Lupus nephritis	0 patients out of 69 patients experienced a relapse of lupus nephritis after COVID-19 vaccination; absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 3% to 5% in those with lupus nephritis; 16 cases of lupus nephritis after COVID-19 vaccine reported, with a cumulative incidence rate of 0.007/100000 person years (P-value = 0.021)
Canney et al[21], 2022		Membranous nephropathy	The absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 1% to 2% in those with membranous nephropathy
Carrillo et al[18], 2023		Autoimmune glomerulonephritis	Incidence of autoimmune glomerulopathy was significantly higher post-Spanish vaccine (COVID-19 vaccine) (n = 85, 50.6%) than pre-Spanish vaccine (n = 86, 39.4%) (P-value=0.029), a total of 17 (20%) took place in the first 6 weeks after SARS-CoV-2 vaccine
Canney et al[21], 2022		ANCA-associated glomerulonephritis	The absolute increase in risk of a disease flare associated with a second or third dose of a COVID-19 vaccine varied from 1% to 2% in those with ANCA-glomerulonephritis
Canney et al[21], 2022; Wang et al[23], 2024		Unspecified glomerulonephritis	Hazard ratio of the second and third dose to glomerular disease was significant at 2.16 (1.03-4.51, P-value = 0.04), the hazard ratio for the first dose was less significant at 0.65 (0.32-1.32); vaccination did not associate with higher risk of subsequent glomerulonephritis disease worsening (HR = 1.02, 95%CI: 0.79-1.33); furthermore, COVID-19 vaccination was not associated with decline in eGFR following vaccination
Kim et al[77], 2024		Renal vasculitis	3 cases of renal vasculitis after COVID-19 vaccine reported, with a cumulative incidence rate of 0.001/100000 person years
Chen et al[78], 2023		Atypical haemolytic uraemic syndrome (aHUS)	Out of 21 patients, only 1 patient had transient aHUS disease instability, but it was self-limited
Kim et al[77], 2024		Immune thrombotic thrombocytopenic purpura leading to AKI	13 cases of thrombotic thrombocytopenia purpura after COVID-19 vaccine reported, with a cumulative incidence rate of 0.006/100000 person years

¹Disproportionality analyses (reporting odds ratio, information component) indicate reporting signals rather than incidence or risk.

AKI: Acute kidney injury; ROR: Reporting odds ratio; PRR: Proportional reporting ratio; IC: Information component; IC₀₂₅: Lower 95% credibility interval of information component; EBGM: Empirical Bayes geometric mean; EBGM₀₅: Lower 5% bound of empirical Bayes geometric mean; WHO: World Health Organization; COVID-19: Coronavirus Disease 2019; TIN: Tubulointerstitial nephritis; MCD: Minimal change disease; CI: Confidence interval; ICSR: Individual case safety reports; IgA: Immunoglobulin A; mRNA: Messenger ribonucleic acid; SLE: Systemic lupus erythematosus; GBM: Glomerular basement membrane; HR: Hazard ratio; VAERS: Vaccine Adverse Event Reporting System; MAKE: Major adverse kidney event; eGFR: Estimated glomerular filtration rate; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; ANCA: Antineutrophil cytoplasmic antibody; aHUS: Atypical haemolytic uraemic syndrome; VigiBase: World Health Organization global pharmacovigilance database.