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

Table 3 Population-level renal outcomes reported following influenza vaccination¹

Ref.	Type of vaccine	Associated kidney injury	Incidence
Hao et al[33], 2023; Miskulin et al[38], 2018; Liao et al[47], 2022	Unspecified vaccine	Patients with CKD or/and/or need haemodialysis	Risk of CKD occurrence among vaccinated patients all season (adjusted hazard ratio: 0.38, 95%CI: 0.34-0.44); risk of haemodialysis after vaccination (aHR: 0.41, 95%CI: 0.33-0.51) all season; receipt of high dose trivalent vaccine was associated with a significant reduction in hospitalization compared to standard dose vaccines (hazard ratio = 0.93; 95%CI: 0.86-1.00; P-value=0.04); patients who had previous influenza vaccine had a lower risk of septicaemia (OR = 0.77, 95%CI: 0.68-0.87), need for intensive care (OR = 0.85, 95%CI: 0.75-0.96), and in-hospital mortality (OR = 0.56, 95%CI: 0.39-0.82) compared to people who did not take the influenza vaccine previously
Pabico et al[51], 1974; Hwang et al[61], 2025		General glomerulonephropathies	Creatinine clearances remained relatively unchanged in all patients; patients with glomerulopathies had no adverse effects with influenza vaccination; VigiBase disproportionality analysis: ROR of Glomerulonephritis with influenza vaccine of 7.08 (6.32-7.93), with an IC of 2.78 (IC025: 2.59)
Shih et al[43], 2018; Cho et al[44], 2024; Zhuo et al[45], 2026; Hwang et al[61], 2025; Vesikari et al[80], 2011; Haber et al[81], 2014		General acute kidney injury (AKI)	Risk of hospitalization for AKI (aOR = 0.67, 95%CI: 0.63-0.72, P-value < 0.001) in vaccinated individuals; unvaccinated individuals who developed influenza infection also had higher AKI risk (aOR = 1.78, 95%CI: 1.57-2.01, P-value < 0.001); adjusted incidence rate ratios of AKI with influenza vaccination 0.83 (95%CI: 0.79-0.87) in the 2018-2019 season and 0.86 (95%CI: 0.82-0.90) in 2019-2020; incidence of AKI was 36.8 per 100000 person years in unvaccinated patients, incidence of AKI was 30.6 per 100000 person years in vaccinated patients, showing a hazard ratio of 0.83 (95%CI: 0.71-0.98) between influenza vaccine and AKI; VigiBase disproportionality analysis: ROR of AKI with influenza vaccine of 0.84 (0.76-0.93), with an IC of -0.25 (IC025: -0.42); one case of a renal and urinary tract disorder, 36-72 months after administration of the trivalent influenza vaccine without the MF59 adjuvant being reported; in a VAERS analysis of a trivalent live attenuated vaccine, there was one report of acute renal failure after vaccination
Hwang et al[61], 2025		TINs	VigiBase disproportionality analysis: ROR of TINs with influenza vaccine of 0.65 (0.46-0.93), with an IC of -0.61 (IC025: -1.21)
Ishimori et al[32], 2023; Ishimori et al[40], 2021; Kumar et al[41], 2023; Ishimori et al[54], 2020	Inactivated seasonal vaccine	Nephrotic syndrome	Relapse rate was not significantly different between the pre-vaccination period and the post vaccination period between the day of vaccination and 30 days after (0.38 times/person-year vs 0.19 times/person-year); children receiving the influenza vaccine showed a significantly lower RR for nephrotic syndrome relapse (RR: 0.22, 95%CI: 0.14-0.35) compared with unvaccinated children; among vaccinated children, there was a significantly lower risk for nephrotic syndrome relapse during the post-vaccination period (RR: 0.31, 95%CI: 0.17-0.56) compared with the pre-vaccination period; nephrotic syndrome relapses significantly reduced in the vaccinated children (P-value < 0.001), with the odds of them getting a nephrotic relapse after influenza vaccine being 0.29 (95%CI: 0.16-0.54); Incidence of nephrotic syndrome relapse is 1.19 times/person-year; comparing it with the various time periods post vaccination, risk ratio for post vaccination days 0-30 is 1.04 (95%CI: 0.82-1.89); risk ratio for days 31-60 is 1.33 (95%CI: 0.94-2.10); risk ratio for days 61-90 is 1.19 (95%CI: 0.94-2.10); risk ratio for days 91-120 is 1.19 (95%CI: 0.94-2.10); risk ratio for days 121-180 was 1.11 (95%CI: 0.98-1.76); steroid injection at first vaccination increases risk for NS relapses over all periods (RR: 3.01, 95%CI: 2.18-4.17)
Klifa et al[39], 2019		Idiopathic nephrotic syndrome	Relapse rates were reported to be not increased in vaccinated children compared to unvaccinated children; relapse rates were not increased in the 6 months following vaccination (1/14) compared to the 6 months before vaccinations (5/14)
		Minimal change disease with acute tubular injury and acute interstitial nephritis	No relevant statistics found
Gwynn et al[53], 2020		Immune-mediated glomerulonephritis	7 patients developed immune-mediated adverse events at the 60-day mark after influenza vaccine, with 1 of the patients (13%) developing grade 3 nephritis 57 days post inactivated influenza vaccine
		Mixed-type cryoglobulinaemic glomerulonephritis	No relevant statistics found
		Henoch-Schönlein purpura-associated nephritis	No relevant statistics found
		Systemic lupus erythematosus-associated nephritis	No relevant statistics found
		Relapsing membranous nephropathy with AKI	No relevant statistics found
Jeffs et al[49], 2015		Pauci-immune vasculitis-associated glomerulonephritis	No significant change in disease activity in vaccinated patients compared with non-vaccinated patients as measured by ANCA titre; no evidence of change in CRP, Birmingham Vasculitis Activity Score (BVAS) or serum creatinine; no significant change in the level of ANCA immune-fluorescence, ANCA IgG, anti-CCP, anti-dsDNA or RF among the vaccinated healthy individuals compared with their non-vaccinated counterparts at either day 7 or 28
		Leukocytoclastic vasculitis-associated glomerulonephritis	No relevant statistics found
		Polyarteritis causing glomerulonephritis with epithelial crescents	No relevant statistics found
		Focal segmental glomerulosclerosis in a patient with IgA nephropathy	No relevant statistics found
		Acute renal failure due to acute tubule-interstitial nephropathy	No relevant statistics found
		Atypical haemolytic urinary syndrome causing AKI	No relevant statistics found
Lee et al[68], 2023		Thrombotic thrombocytopenic purpura causing acute renal failure	VigiBase disproportionality analysis: ROR influenza vaccines related thrombotic thrombocytopenic syndrome of 0.82 (0.77-0.88) and IC: -0.28 (IC025: -0.39)
		Milk alkali syndrome-associated AKI	No relevant statistics found
Chen et al[46], 2025; Chen et al[50], 2022		AKI due to rhabdomyolysis	Statins use 1-30 days before the date of rhabdomyolysis was associated with a higher odds of rhabdomyolysis with the use of influenza vaccine within 1-7 days of the date of rhabdomyolysis, 1.67 (95%CI: 1.04-2.69, P-value = 0.034); individuals who developed rhabdomyolysis were less likely to have received an influenza vaccine within the preceding 28 days (OR = 0.65, 95%CI: 0.52-0.82)
		Hemophagocytic lymphohistiocytosis complicated by Rhabdomyolysis, causing AKI	No relevant statistics found
		Septic shock after seasonal influenza vaccine leading to multiorgan failure	No relevant statistics found
		Systemic capillary leak syndrome	No relevant statistics found
		Acute disseminated encephalomyelitis after seasonal influenza vaccine leading to AKI	No relevant statistics found
Levison et al[42], 2022; Souayah et al[82], 2007		Nephrotic syndrome with Guillain-Barré syndrome (GBS)	Influenza vaccination was linked to a mildly higher risk of GBS [OR = 1.94 (95%CI: 1.12-3.36)], particularly in the month following vaccination [OR = 2.9 (95%CI: 1.2-6.8)]; recent vaccination accounted for only 1.5% of GBS cases, corresponding to a population-attributable fraction of 0.4%; in a VAERS analysis in 2004, there were 31 cases of Guillain barre syndrome reported after influenza vaccine
		GBS is causing renal salt-wasting syndrome	No relevant statistics found
Dos Santos et al[37], 2016; Zawiasa-Bryszewaska et al[55], 2025		Safety in patients with a kidney transplant	RI of kidney rejection during the 30-day risk period was 0.59 (95%CI: 0.13-2.63), 1.28 (95%CI: 0.52-3.15), 0.98 (95%CI: 0.34-2.80) and 0.91 (0.44-1.87) in seasons 2006/07, 2007/08, 2008/09 and pooled seasons, respectively; corresponding RIs during the 60-day risk period were 050 (95%CI: 0.16-1.60), 0.82 (95%CI: 0.36-1.86), 0.42 (95%CI: 0.15-1.21) and 0.59 (95%CI: 0.32-1.08), respectively; no significant difference in eGFR before and after vaccine (Difference of eGFR from day of vaccine to 6 months after in vaccinated group [-1.0 (-5.0 to 2.0) mL/minute/1.73 m2] vs in non-vaccinated group, [1.0 (-3.0 to 5.0) mL/min/1.73 m2]; no significant difference in serum creatinine levels (difference in serum creatinine levels from day of vaccination to day 60 after vaccination in vaccinated group and non-vaccinated group, respectively, -1.27 (-1.71 to -0.90) vs -1.07 (-1.40 to -0.89) mg/dL; no significant difference in clinically significant proteinuria rates (Proteinuria rates from day 60 post vaccination in vaccinated vs non-vaccinated patients 7.4% vs 5.8%
Fernández-Ruiz et al[35], 2015		Kidney graft rejection post-influenza vaccine	Overall cumulative incidence of biopsy-proven acute graft rejection was 2 out of 37 (5.4%) patients who took the adjuvanted vaccine and 2 out of 28 (7.1%) patients who took the non-adjuvanted vaccine; the incidence rate was 0.22/1000 transplantdays for adjuvanted vaccinations and 0.18/1000 transplant days for non-adjuvanted vaccinations; the overall cumulative incidence of graft loss was 0 who took the adjuvanted vaccine and 2 out of 28 (7.1%) patients who took the non-adjuvanted vaccine; the incidence rate was 0.18/1000 ctransplant days for non-adjuvanted vaccinations
Reynales et al[52], 2012	Inactivated H1N1 pandemic vaccine	Incidence of renal and urinary disorders in MF59® adjuvanted cell culture-derived vaccine	Cumulative Incidence of urinary and renal disorders during the study is reported tobe 0.1% (CI: 0.0-0.3); however, 0 cases are reported to be possibly related to the vaccine and related to the vaccine
		Relapse of nephrotic syndrome	No relevant statistics found
		Henoch-Schönlein purpura nephritis	No relevant statistics found
		Membranous glomerulonephritis causing nephrotic syndrome	No relevant statistics found
		AKI due to rhabdomyolysis	No relevant statistics found
		Multiorgan failure after influenza vaccine	No relevant statistics found
		Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome causing AKI	No relevant statistics found
		Serum sickness with AKI	No relevant statistics found
Moghaddasi et al[34], 2013; Cohet et al[36], 2016		Renal allograft function and transplant rejection	The serum creatinine, creatinine clearance, and 24-hour urine proteinuria levels were not significantly different between before and 1 month after vaccination (1.3 ± 0.35 mg/dL vs 1.3 ± 0.5 mg/dL, 83 ± 28 mL/minute vs 78 ± 31 mL/minute, and 356 ± 437 mg vs 293 ± 307 mg, respectively); serum creatinine level did not differ significantly between before and 2.5 years after vaccination (1.3 ± 0.35 mg/dL vs 1.4 ± 0.39 mg/dL); the RI of acute transplant rejection adjusted for time since transplantation was 0.85 (95%CI: 0.38-1.90) within 30 days after vaccination and 0.68 (95%CI: 0.33-1.40) within 60 days after vaccination

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

CKD: Chronic kidney disease; CI: Confidence interval; aHR: Adjusted hazard ratio; ROR: Reporting odds ratio; IC: Information component; IC₀₂₅: Lower 95% credibility interval of the information component; AKI: Acute kidney injury; MF59: Squalene-based oil-in-water vaccine adjuvant; VAERS: Vaccine Adverse Event Reporting System; RR: Risk ratio; NS: Nephrotic syndrome; ANCA: Antineutrophil cytoplasmic antibody; CRP: C-reactive protein; BVAS: Birmingham Vasculitis Activity Score; IgG: Immunoglobulin G; CCP: Cyclic citrullinated peptide; RF: Rheumatoid factor; GBS: Guillain-Barré syndrome; RI: Resistive index; eGFR: Estimated glomerular filtration rate; DRESS: Drug reaction with eosinophilia and systemic symptoms.