New sights into new-onset and relapsed minimal change disease post COVID-19 vaccination:A systemic review of the clinical characteristics and underlying pathogenesis

Background::Minimal change disease(MCD)following coronavirus disease 2019(COVID-19)vaccination has been increasingly reported;however,the clinical characteristics and pathogenesis of patients with MCD have not been thoroughly discussed.Methods::A systematic literature search of published data up until May 10,2023,was conducted using the PubMed,Embase,Cochrane Library,Web of Science,and SinoMed databases.MCD patients diagnosed by renal biopsy following COVID-19 vaccination were analyzed with the largest sample size to date.Results::A total of 85 patients were included in the present statistical analysis,including 50 new-onset and 35 relapsed MCD subjects following COVID-19 vaccination.Compared with new-onset MCD patients,the relapsed patients had previously suffered from one or two other diseases(12/50 vs.34/35,p<0.001).The laboratory results indicated that new-onset MCD was more serious than MCD relapse,as evidenced by higher serum creatinine(p=0.036)and urinary protein levels(p<0.001),along with lower levels of serum albumin(p<0.001).The new-onset subjects responded to corticosteroids alone,while the relapsed patients acquired combined therapies involving immunosuppressants and steroids(p<0.001).Compared with MCD onset after two vaccine doses,those who immediately flared after the first vaccination had more comorbidities(p=0.011).Comparatively,the first dose-onset patients showed a higher response rate to treatments than the second dose-onset patients(44/50 vs.22/35,p=0.017).Conclusions::New-onset MCD was more severe than relapsed MCD in terms of laboratory results and clinical manifestations after COVID-19 vaccination.Overall,combining both corticosteroid therapy and immunosuppressive treatment yields an effective approach to managing the condition.