URETERAL COLIC ASSOCIATED WITH

ASTRAZENECA VACCINATION, CASE REPORT

Vitorino Modesto dos Santos 1,2*, Lister Arruda Modesto dos Santos 3

We report on the repeated occurrence of ureteral colic episodes after each

dose of the Astra Zeneca vaccine against SARS-CoV-2. A 78-year-old man,

with an episode of urinary stone three years previously, presented acute crisis

of ureteral colic due to calculi following the vaccinations. In the episode after

the rst injection the patient was treated at home and the stone was eliminated

without invasive procedures; while in the second one he needed to undergo

a double J catheter because of a moderate obstruction. Although urological

manifestations have been described in relation to COVID-19 vaccination, in

the present case at least a temporal relationship was observed between the

ureteral colic episodes and the AstraZeneca vaccine without a conrmed

causality. The purpose of this report is to increase the interest of health care

workers about eventual adverse effects of COVID-19 vaccines, in this case

by AstraZeneca product.

Informamos sobre la aparición repetida de episodios de cólicos ureterales

después de cada dosis de la vacuna Astra Zeneca contra el SARS-CoV-2.

Varón de 78 años, con un episodio de litiasis urinario tres años antes, que

presentó crisis aguda de cólico ureteral por litiasis tras las vacunaciones.

En el episodio posterior a la primera inyección se trató al paciente en su

domicilio y se eliminó el cálculo sin procedimientos invasivos; mientras que

en el segundo debió someterse a un catéter doble J por una obstrucción

moderada. Aunque se han descrito manifestaciones urológicas en relación

con la vacunación contra la COVID-19, en el presente caso se observó

al menos una relación temporal entre los episodios de cólico ureteral y la

vacuna de AstraZeneca sin causalidad conrmada. El propósito de este

informe es aumentar el interés de los trabajadores de la salud sobre los

eventuales efectos adversos de las vacunas contra el COVID-19, en este

caso del producto AstraZeneca.

REPORTE DE CASO

Revista Médica Vozandes

Volumen 33, Número 1, 2022

Resumen

CÓLICO URETERAL ASOCIADO A LA VACUNACIÓN POR

ASTRAZENECA, REPORTE DE CASO

Abstract

Keywords: COVID-19; SARS-CoV-2; Urologic symptoms; Vaccine.

Forma de citar este artículo: Santos

VM, Santos LAM. URETERAL COLIC

ASSOCIATED WITH ASTRAZENECA

VACCINATION, CASE REPORT . Rev Med

Vozandes. 2022; 33 (1): 49 - 53

1.Armed Forces Hospital. Department of Internal Medi-

cine. Brasília-DF – Brazil.

2.Catholic University of Brasília. Brasília-DF – Brazil.

3.Instituto de Assistência Médica ao Servidor Público

Estadual – IAMSPE. Department of Advanced General

Surgery and Oncosurgery. São Paulo-SP – Brazil

ORCID ID:

Vitorino Modesto dos Santos

orcid.org/0000-0002-7033-6074

Lister Arruda Modesto dos Santos

orcid.org/0000-0003-4647-4044

*Corresponding author: Modesto dos Santos

Vitorino

E-mail: vitorinomodesto@gmail.com

Este artículo está bajo una

licencia de Creative Com-

mons de tipo Reconocimien-

to – No comercial – Sin obras

derivadas 4.0 International.

Received: 25 – Aug – 2021

Accepted: 30 – Apr – 2022

Publish: 01 – Jun – 2022

Conflict of interest: The authors have full

freedom of manuscript preparation, and there were no

potential conicts of interest.

CARE 2017 Check List statement: The authors

have real the CARE 2017 Check List and the

manuscript was prepared and revised according

to the CARE 2017 Checklist.

Financial disclosure: The authors have no nan-

cial relationships relevant to this article to disclose.

Authors’ contribution: The authors equally

contributed to this work: study conception and design,

acquisition of data, analysis and interpretation of data,

drafting of manuscript and critical revision.

DOI: 10.48018/rmv.v33.i1.4

Palabras clave: COVID-19; SARS-CoV-2; Síntomas urológicos; Vacuna.

50 Revista Médica Vozandes

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dos Santos Vitorino M et al.

The growing number of people receiving

complete schedule of vaccination all over the

world, may propitiate better understand the

current ndings about COVID-19 manifestations

and the adverse effects caused by specic

vaccines in all the age-groups. The case study

herein reported aims to call attention to the

episodes of ureteral lithiasis occurring four weeks

after both doses of the Astra Zeneca vaccine.

CASE PRESENTATION

A 78-year-old male with an antecedent of right

ureteral lithiasis three years ago managed by

non-invasive procedures, recently underwent the

Astra Zeneca vaccines. One month after each

dose of vaccination he had hematuria and right

ureteral colic pain. His rst episode was controlled

at home by oral medicines and the spontaneous

stone elimination; in the second, the pain was more

intense and he needed hospitalization. Physical

examination was unremarkable, with BMI: 25.5

kg/m2. The results of routine blood tests are shown

in table 1; while the urinalysis revealed specic

gravity: 1.025 (1.016-1.022), pH: 6.5, protein: 3+

(negative), glucose: absent, hemoglobin: 4+,

nitrites: negative, leukocytes: 4.4 /HPF (< 5.0 /HPF),

INTRODUCTION

The interest in urology events related to COVID-19 scenery

has increased both due to the action of the virus at the

kidneys and in emergency care by this specialty. (1-15) This

includes acute kidney injury and nephrotic syndrome after

COVID-19 vaccine. (6,7,12) Hematuria and urinary infection are

uncommon symptoms reported following the vaccination;

however, a denite causal relationship stands to be entirely

established. (12) Kidneys are targets of SARS-Cov-2 and tubular

lesions associated with angiotensin-2 converting enzyme and

cytokine storm increase the mortality rate of COVID-19. (13-15)

Viral particles can be detected in the urine, as well as proximal

tubules and podocytes causing acute proximal necrosis and

segmental glomerulosclerosis in infected people. Besides,

activated coagulation can glomerular ischemia, necrosis

and brosis. (13-15)

There was also impact of COVID-19 on urolithiasis emergency

management, with a reduction of the admissions; and the

admitted patients had more complications and underwent

the endoscopic extraction more often than urinary drainage

only. (2-5,9-11) Patients with urolithiasis have been often managed

by medical treatment at home. (4,5,9,11) Medical expulsive therapy

(MET) including tamsulosin is used for distal ureteral stone, but

endoscopic management may be the option to control the

persistent colic pains; and spinal anesthesia is preferred for

patients with COVID-19 to health workers protection. (3)

URETERAL COLIC ASSOCIATED WITH

ASTRAZENECA VACCINATION (...)

Figure 1 . ECT images of the urinary calculus (measuring 5 mm) in the middle third of the right

ureter (arrows), which caused moderate pyelocaliceal dilatation upstream.

Source: Authors

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red cells: 409 /HPF (< 3 /HPF), cylinders: absent, bacteria: <

30 /HPF (< 30 /HPF), and epithelial cells: < 3 /HPF (< 3 /HPF).

The computed tomography (CT) of admission revealed the

calculus (arrows) of 5 mm in the middle third of the right ureter

(Figure 1), which caused moderate dilatation upstream.

The patient underwent amoxicillin/ clavulanic acid (7

days), paracetamol, scopolamine/ dipyrone, codeine,

tamsulosin, endoscopic lithotripsy, and double J catheter

(Figure 2). The decision of the urological team was for the

local plus spinal anesthetic procedures. CT images three

weeks later revealed normal urine ux and the catheter

was retired. Worthy of note, the patient denied any local or

systemic reactions to vaccination; and after the two doses,

the SAR-Cov-2 neutralizing antibodies titer (ELISA) was 94%.

Currently, he follows asymptomatic and performing all the

normal daily activities maintaining the recommended liquid

ingestion, and the preventive care to COVID-19.

DISCUSSION

The elderly man herein described had repeated

hematuria and right ureteral colic pain nearly 30

days after each dose of the Astra Zeneca vaccine

against SARS-CoV-2. Three years ago he was

admitted to the Emergency to treat an episode

of urolithiasis, successfully managed by a non-

invasive procedure with rapid elimination of the

stone. He evolved asymptomatic and with all the

yearly routine exams unremarkable, before the

urological disorders causally or by chance having

association with the vaccination. The diagnosis of

ureteral lithiasis was conrmed by abdominal CT

imaging studies, and hospitalization was needed

for treatment, in spite of the risk due to a pandemic

period. The urological manifestations (hematuria

and renal colic) do not appear causally related

Figure 2 . Abdominal CT of control showing the proximal extremity of a double-J-ureteral

catheter at the upper calyx, and the distal end within the bladder (arrows).

Source: Authors

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CONCLUSION

Exact spectrum and incidence of COVID-19

vaccines adverse events still lack. SARS-Cov-2

particles are found in the urine, and in the

renal and urinary bladder cells. Hence, the

health professionals, in special those of the

urological teams, should adopt measures to

avoid contamination by urine in management

of patients with COVID-19. The impact of

COVID-19 on urolithiasis emergency care reduced

the admissions and increased telemedicine

consultations, with possible risk of higher rate of

complications. Physicians should be attentive

with respect to unsuspected adverse events of

vaccines. Case reports contribute to enhance the

awareness of non-specialists about these issues.

Table 1. Routine determinations on admission

Parameters (normal ranges) Results

Hemoglobin (13.0-18.0 g/dl) 15.10

Hematocrit (42-52%) 45

Leukocytes (4,000-11,000/mm3) 12,300

Lymphocytes (740-5,500/mm3) 1,107

Platelets (140,000-450,000/mm3) 258,000

Aspartate aminotransferase (< 34

IU/L)

Alanine aminotransferase (< 49

IU/L)

Gamma glutamyltransferase (< 73

IU/L)

Urea (19.0-49.0 mg/dl) 55.0

Creatinine (0.7-1.2 mg/dl) 1.0

Sodium (132-146 mmol/L) 140

Potassium (3.5-5.1 mmol/L) 3.8

Calcium (8.3-10.6 mg/dl) 9.2

Phosphorus (2.5-4.8 mg/dl) 3.1

Magnesium (1.3-2.7 mg/dl) 1.9

Uric acid (2.0-5.0 mg/dl) 3.5

C-Reactive protein (< 0.5 mg/dl) 2.74

Glucose (70-99 mg/dl) 96

Total cholesterol (< 190 mg/dl) 163

Tryglicerides (< 150 mg/dl) 132

Erythrocyte sedimentation rate (<

24 mm/1h)

Urocultures Negative

Admission on June 23rd, 2021.

Source: Authors

to vaccination but coincidentally occurred after both doses.

Similar phenomenon could not be detected through the

revision of current literature data; nevertheless, one cannot

be sure to rule out the possibility of other underreported

cases. Interestingly, though likely without clinical implications,

the FDA Vaccine Adverse Event Reporting System included

the 3 incidental renal cysts as “adverse symptoms”; and the

inclusion could represent the entire spectrum of the urological

manifestations. (12) In the second episode, the patient

underwent oral antimicrobial, analgesics, and long-acting

alpha-blocker schedules; and endoscopic lithotripsy followed

by double J catheter insertion. The recommended prevention

for COVID-19 was strictly observed during admission. The

uneventful surgical procedures and the postoperative course

had 2 days of duration.

The human organs containing target cells and more often

described with SARS-Cov-2 invasion are the lungs, heart,

ileum, esophagus, pancreas, urinary bladder, and kidneys.

(10) There has been a growing interest in diverse urological

aspects related to the physiopathology of COVID-19 as well

as to the different kinds of available vaccines. (2-15) As a whole,

adverse consequences of routine changes in the assistance

of patients with symptomatic urolithiasis should merit attention

of specialists in the whole world. (2-5,9-11) Priority in attending and

admitting patients with COVID-19 have caused a reduction in

the outpatient consultations and hospitalizations of individuals

with urolithiasis, which is the main urological emergency with

admissions increasing in the last decade. (2-5,9-11) Therefore, a

worsening of clinical manifestations and more complications

can result, in a context of conservative management and

telemedicine for more complex cases. (2-5,9-11)

The most described adverse events associated with

vaccination against COVID-19 are local reactions, but

non-specic symptoms occur as fatigue, tinnitus, pruritus,

nausea, vomiting, diarrhea, headache, chills, fever, myalgia,

arthralgia, parethesia, lymphadenopathy, thromboembolism,

anaphylaxis, and circulatory shock. (6-8,12,15) While the more

frequently described urological disorders include hematuria,

acute kidney injury (AKI), minimal change disease (MCD), and

full-blown nephrotic syndrome. (6,7,12)

Physiopathological and histopathological evidence has

contributed to better clear the urological disorders of

COVID-19 as well as the vaccine adverse reactions.(3,6,7,12) MCD

and nephrotic syndrome can be related to T cell-mediated

podocyte damage. (6,7,14) AKI may be due to impaired renal

perfusion and endothelial lesion by a cytokine storm, or viral

invasion of renal tissue involving the angiotensin-converting

enzyme 2.(3,6,10,13,14) Biopsy evaluations showed cases of

extensive acute tubular necrosis, and revealed SARS-Cov-2

protein antigens in renal tubular and endothelial cells. (6,13,14)

Moreover, viral particles can be found in urine, favoring

transmission to health care workers. (10,13,14)

dos Santos Vitorino M et al.

URETERAL COLIC ASSOCIATED WITH

ASTRAZENECA VACCINATION (...)

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