Copyright: ©Author(s) 2026.
World J Nephrol. Jun 25, 2026; 15(2): 118214
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118214
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118214
Table 1 Risk of bias assessment of included studies using the risk of bias in non-randomised studies - of interventions tool
| Ref. | Vaccine | Confounding | Selection of participants | Exposure classification | Deviations from intended interventions | Missing data | Outcome measurement | Selection of reported results | Overall risk of bias |
| Kamei et al[10], 2023 | COVID-19 | Serious | Moderate | Low | Moderate | Low | Low | Moderate | Serious |
| Waldman et al[11], 2023 | COVID-19 | Serious | Serious | Low | Low | Moderate | Low | Moderate | Serious |
| Sanders et al[12], 2022 | COVID-19 | Serious | Moderate | Low | Low | Moderate | Low | Moderate | Serious |
| Wan et al[13], 2022, | COVID-19 | Low | Moderate | Low | Low | Moderate | Moderate | Low | Moderate |
| Yechezkel et al[14], 2023 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Moderate | Low | Moderate |
| Choi et al[15], 2024 | COVID-19 | Moderate | Low | Low | Low | Low | Serious | Moderate | Moderate |
| Lionaki et al[16], 2024 | COVID-19 | Moderate | Moderate | Low | Low | Low | Moderate | Low | Moderate |
| Poster Abstracts[17], 2022 | COVID-19 | Serious | Moderate | Low | Low | Moderate | Low | Moderate | Serious |
| Carrillo et al[18], 2023 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Chen et al[19], 2023 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Diebold et al[20], 2022 | COVID-19 | Low | Low | Low | Low | Low | Low | Low | Low |
| Canney et al[21], 2022 | COVID-19 | Low | Low | Low | Low | Low | Low | Low | Low |
| Ota et al[22], 2023 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Wang et al[23], 2024 | COVID-19 | Low | Low | Low | Low | Low | Low | Low | Low |
| Sun et al[24], 2024 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Nagatsuji et al[25], 2024 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Aoki et al[26], 2024 | COVID-19 | Serious | Serious | Low | Low | Moderate | Low | Moderate | Serious |
| Zhang et al[27], 2024 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Low | Moderate |
| Mazza et al[28], 2025 | COVID-19 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Thepveera et al[29], 2025 | COVID-19 | Moderate | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
| Tsai et al[30], 2025 | COVID-19 | Moderate | Low | Low | Low | Low | Moderate | Low | Moderate |
| Huang et al[31], 2025 | COVID-19 | Moderate | Low | Low | Low | Low | Moderate | Low | Moderate |
| Ishimori et al[32], 2023 | Influenza | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Hao et al[33], 2023 | Influenza | Moderate | Low | Low | Low | Moderate | Moderate | Moderate | Moderate |
| Moghaddasi et al[34], 2013 | Influenza | Serious | Serious | Low | Low | Moderate | Low | Moderate | Serious |
| Fernández-Ruiz et al[35], 2015 | Influenza | Serious | Moderate | Low | Low | Moderate | Low | Moderate | Serious |
| Cohet et al[36], 2016 | Influenza | Low | Low | Low | Low | Low | Moderate | Low | Low |
| Dos Santos et al[37], 2016 | Influenza | Low | Low | Low | Low | Moderate | Low | Low | Low |
| Miskulin et al[38], 2018 | Influenza | Moderate | Low | Low | Low | Moderate | Low | Moderate | Moderate |
| Klifa et al[39], 2019 | Influenza | Serious | Serious | Moderate | Low | Moderate | Moderate | Moderate | Serious |
| Ishimori et al[40], 2021 | Influenza | Moderate | Moderate | Low | Low | Moderate | Moderate | Low | Moderate |
| Kumar et al[41], 2023 | Influenza | Moderate | Moderate | Low | Low | Moderate | Low | Low | Moderate |
| Levison et al[42], 2022 | Influenza | Low | Low | Low | Low | Low | Low | Low | Low |
| Shih et al[43], 2018 | Influenza | Moderate | Low | Low | Low | Low | Low | Low | Moderate |
| Cho et al[44], 2024 | Influenza | Low | Low | Low | Low | Low | Low | Low | Low |
| Zhuo et al[45], 2026 | Influenza | Moderate | Low | Low | Low | Low | Moderate | Low | Moderate |
| Chen et al[46], 2025 | Influenza | Moderate | Low | Low | Low | Low | Moderate | Low | Moderate |
| Liao et al[47], 2022 | Influenza | Moderate | Low | Low | Low | Low | Low | Low | Moderate |
| Sheth et al[48], 1979 | Influenza | Serious | Serious | Low | Moderate | Moderate | Moderate | Moderate | Serious |
| Jeffs et al[49], 2015 | Influenza | Low | Low | Low | Moderate | Low | Low | Low | Low |
| Chen et al[50], 2022 | Influenza | Moderate | Low | Low | Low | Low | Moderate | Low | Moderate |
| Pabico et al[51], 1974 | Influenza | Serious | Moderate | Low | Moderate | Low | Low | Moderate | Serious |
| Reynales et al[52], 2012 | Influenza | Serious | Moderate | Low | Low | Low | Moderate | Low | Serious |
| Gwynn et al[53], 2020 | Influenza | Serious | Moderate | Low | Moderate | Low | Moderate | Moderate | Serious |
| Ishimori et al[54], 2020 | Influenza | Moderate | Moderate | Low | Moderate | Low | Low | Low | Moderate |
| Zawiasa-Bryszewska et al[55], 2025 | Influenza | Moderate | Moderate | Low | Moderate | Moderate | Moderate | Low | Moderate |
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 |
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 | |
| 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 |
- Citation: Aye Kyaw YH, Yip P, See KC. Post vaccination acute kidney injury and other renal complications after COVID-19 and influenza vaccination. World J Nephrol 2026; 15(2): 118214
- URL: https://www.wjgnet.com/2220-6124/full/v15/i2/118214.htm
- DOI: https://dx.doi.org/10.5527/wjn.v15.i2.118214