Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118214
Revised: January 14, 2026
Accepted: March 3, 2026
Published online: June 25, 2026
Processing time: 170 Days and 18.2 Hours
Vaccination remains a cornerstone of public health, yet concerns regarding serious adverse events continue to contribute to vaccine hesitancy. While systemic and local vaccine reactions are well described, renal complications such as acute kidney injury (AKI) and immune-mediated glomerular disease are less well characterised. With widespread and sustained use of coronavirus disease 2019 (COVID-19) and influenza vaccines, a comprehensive synthesis of reported renal adverse outcomes is needed.
To synthesise and critically evaluate the existing evidence on AKI and other renal manifestations reported following influenza and COVID-19 vaccination. Spe
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and EMBASE were searched from inception to 6 December 2025 for studies reporting renal outcomes following COVID-19 or influenza vaccination. Eligible studies included observational studies, pharmacovigilance analyses, case reports, and case series. Data on incidence, clinical presentation, timing of onset, management, and outcomes were extracted and synthesised narratively due to heterogeneity. Risk of bias in observational studies was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.
A total of 255 COVID-19 vaccine-related studies and 73 influenza vaccine-related studies met the inclusion criteria, supplemented by additional studies identified through reference screening. Population-level observational studies consistently demonstrated a low absolute risk of renal adverse outcomes following vaccination, with several studies reporting reduced AKI-related risk among vaccinated individuals. In contrast, pharmacovigilance analyses and case reports described serious instances of de novo or relapsing renal disease, including minimal change disease, immunoglobulin A nephropathy, membranous nephropathy, pauci-immune glomerulonephritis, and systemic inflammatory syndromes with secondary renal involvement. Symptom onset typically occurred within days to weeks of vaccination. Most cases responded favourably to supportive or disease-specific therapy, with recovery observed over weeks to months; irreversible renal outcomes were uncommon.
Current evidence indicates that both COVID-19 and influenza vaccines are associated with a low population-level risk of adverse renal outcomes. Serious immune-mediated renal events have been reported in temporal association with vaccination, likely reflecting idiosyncratic immune responses or unmasking of pre-existing disease rather than a widespread nephrotoxic effect. The overall benefits of vaccination substantially outweigh potential renal risks. Ongoing surveillance and well-designed population-based studies remain essential to refine risk estimates and identify susceptible subgroups.
Core Tip: Renal adverse events following coronavirus disease 2019 and influenza vaccination are rare at the population level. While case reports describe immune-mediated kidney diseases occurring in temporal association with vaccination, large observational studies consistently demonstrate a low absolute risk of acute kidney injury and other renal outcomes. Clinicians should remain vigilant for unusual renal presentations after vaccination, particularly in high-risk individuals, while continuing to advocate vaccination given its substantial overall benefits.