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 a higher disease history (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.