Minimal change nephrotic syndrome in an 82 year old patient following a tetanus-diphteria-poliomyelitis-vaccination

Abstract Background The most common cause of idiopathic nephrotic syndrome in children and younger adults is the minimal change nephrotic syndrome (MCNS). In the elderly MCNS is relatively uncommon. Over the last decade some reports suggest a rare but possible association with the administration of various vaccines. Case presentation A 82-year old Caucasian female presented with pronounced nephrotic syndrome (proteinuria of 7.1 g/d, hypoproteinemia of 47 g/l). About six weeks prior to admission, she had received a combination vaccination for tetanus, diphtheria and poliomyelitis as a booster-vaccination from her general practitioner. The renal biopsy revealed typical minimal change lesions. She responded well to the initiated steroid treatment. As through physical examination as well as extensive laboratory and imaging studies did neither find any evidence for malignancies nor infections we suggest that the minimal change nephrotic syndrome in this patient might be related to the activation of the immune system triggered by the vaccination. Conclusion Our case as well as previous anecdotal reports suggests that vaccination and the resulting stimulations of the immune system might cause MCNS and other severe immune-reactions. Increased awareness in that regard might help to expand the database of those cases.</p

Morfologicheskaja kartina perifericheskojj krovi u derevenskikh detejj, inficirovannykh parazitami pishhevaritel'nogo trakta

Coprological examinations of 576 children were conducted. In 380 of the children infected were conducted examinations of the alimentary tract and in 100 control cases were conducted haematological examinations. Haematotocrit, SDE, SSHb were determined in 118 infected children and in 77 controls. The following conclusicns were drawn: 1. Rural children infected with intestinal parasites exhibit symptoms of anaemia more commonly and in a major degree (60 per cent), than the children from the same environment and of similar conditions of life, in whom no parasites were found (40 per cent). 2. The present investigations proved that the anaemia had the character of hypochromic macrocytary anaemia. 3. The changes of the white blood cells count, neutrophils and lymphocytes are too small to ascribe to sole responsibility for them to the influence of parasites. 4. An increase cosinophils count was diagnosed in 51,6 per cent of the infested children, but the normal count or even their absence do not exclude the infection of the alimentary tract with parasites. 5. The present observations did not prove that there is a major influense of the infection with intestinal parasites on the cells of the reticulo-endothelial system in the peripheric blood