Pediatric Nephrology Fellow Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Background: Measles infections depress T cell-mediated immunity and have been associated with inducting temporary remission of nephrotic syndrome. Perhaps the administration of the Measles-Mumps-Rubella (MMR) live-attenuated vaccine may induce T cell immunity with resultant protective effects against nephrotic syndrome. Objective: The aim of this study is to assess the association between MMR live-attenuated vaccine and nephrotic syndrome. We hypothesize that the MMR live-attenuated vaccine is protective against nephrotic syndrome. Design/Methods: We obtained demographic and immunization data of pediatric patients diagnosed with nephrotic syndrome between April 2000 and April 2020 and who received care at IU Health Hospitals and Riley Children’s Hospital. We included pediatric patients with an ICD-10 code of nephrotic syndrome and with immunization records available in the database. Children who received care for bone fractures without other chronic medical diagnoses were used as controls. Groups were compared with the Mann-Whitney U test. Results: We analyzed 677 patients with nephrotic syndrome (minimal changes lesions 16.7%, focal and segmental lesions 2.2%, membranous/proliferative/membranoproliferative lesions 20.5%, and other 60.6%) and had vaccine data on 154 patients. These were compared to 2679 controls. The median (IQR) age of the first MMR vaccine in patients with nephrotic syndrome was 1.3 (1.0 to 1.8) years, and the median age of diagnosis was 7.4 (3.6 to 13.1) years. The median (IQR) age of the initial MMR vaccine in controls was 1.1 (1.0 to 1.3) years, and the median age of diagnosis was 9.1 (6.2 to 12) years. Compared to healthy controls, children with nephrotic syndrome received their MMR live-attenuated vaccine later in the immunization schedule (p-value = 4.5e-05).
Conclusion(s): MMR live-attenuated vaccines are administered later in children with nephrotic syndrome. It may be due to immunosuppression delaying the administration of a live vaccine. It is also possible that the administration of MMR live-attenuated vaccine reduces nephrotic syndrome susceptibility and that children with delayed MMR are more susceptible to nephrotic syndrome. This study was limited by our inability to distinguish between no vaccination records and the absence of vaccinations; thus, our results are limited to the age of the initial vaccination. Future studies that prospectively compare MMR vaccination rates in children with and without nephrotic syndrome are needed.