Vaccination and Renal Patients: A critical examination of assumed safety and effectiveness

Suzanne Humphries, MD

Suzanne Humphries, MD

October 4, 2011

“…health is not sacrosanct or free from vested interests.  The traditional grandeur of the learned profession of medicine cannot be taken for granted.  It has to be earned by every new generation of physicians.”[1]

Nephrologists are in the position of overseeing the health of patients with inflammatory kidney diseases of unknown origin, autoimmune disorders, and acute and chronic kidney diseases of many etiologies. A nephrologist is a specialist consultant and the patients we see are often referred by family doctors and internal medicine physicians. Several doctors who routinely refer patients to me have unquestioningly accepted the idea that “vaccines are safe for everyone” and the “benefit outweighs the small risk.”  They inquired about my reasoning to withhold vaccinations in sick kidney patients.

Until I did my own research, I was also uninformed and accepted vaccines as safe and effective. Doctors do not receive any education on vaccine composition and the potential adverse effects.  In medical training, we were told that patients should receive the vaccine schedule, and were assured that vaccines are safe and effective, except perhaps in a very small minority of people – maybe one in a million.

Information given to doctors about the 200-year history of vaccination is limited to carefully selected sound-bites that pre-empt any concerns.  We were led to believe that vaccines are solely responsible for the eradication of infectious diseases such as smallpox.  Most accepted, without question or personal study, that vaccines greatly reduced illnesses and are a benefit to overall human health. Few know that the mortality for “vaccine preventable diseases” had massively declined before the vaccine campaigns began. But it is painfully obvious from figure 1 (at end of document)[2] that the mortality for the major infectious diseases, including those for which no vaccines were ever created, had regressed to nearly undetectable levels in the population – long before vaccines were introduced.

Patients with acute and chronic illnesses are target groups to be heavily vaccinated even though vaccines have barely been tested for safety or long-term consequences in these populations. Most doctors and patients assume that vaccines are simply a solution of sterile saline and “dead” microorganisms.  They are not aware of the manufacturing process to make a vaccine, the contents in the vial, or the potential risks of each component. Doctors wrongly assume that vaccines “protect” their patients from disease, without any adverse consequences on their health, and that vaccinated people won’t get that disease.

Other than vaccines, is there any other drug or biological, that is given across-the-board to all comers, without regard for health status, age, or risk of aggravating an existing illness?  Given the conflict of interest among members of the major vaccine-promoting committees, vaccines fall into a category that deserves independent study by health care providers.

Every patient should be informed about the potential risks of vaccination and the lack of evidence that vaccines will not harm them over the long-term.  Patients have a personal right to choose – and refuse.  Their informed choices should be respected.  But in order for them to be informed, the person informing them would have to be informed – and doctors are not informed.

Autoimmune and inflammatory considerations

Some of the causes of kidney disease are autoimmune, vasculitic (inflammation of blood vessels), and granulomatous (described below).  There are many conditions labeled as “idiopathic”(cause unknown) in nephrology and many are inflammatory in nature.  When will doctors make the connection between vaccination and these adverse events?

A mechanism called “molecular mimicry”[3] occurs when an antibody generated by a vaccine inadvertently recognizes and binds to healthy tissue in the body.  The immune system then senses the antibody-healthy tissue complex as foreign and attacks it. As a result, the previously healthy tissue, such as kidney glomeruli (the tiny filters in the kidney) or small blood vessels in the kidney, can develop significant inflammation and disease. This is an autoimmune reaction (against self).

There is, last but not least, a paucity of clinical and epidemiological data on the potential of vaccines to induce autoimmune hazards. These adverse events, whether they appear days, weeks or months following vaccination, might be frequently overlooked. The awareness of physicians and caregivers to these associations and reports such as the one described in this issue by Vainer-Mossel  et al. might enable better assessment of post-vaccination complications as well as susceptibility and safety issues.”[4]

Vaccines are designed to create a state of inflammation, and raise LDL and CRP levels.[5] Why then would we give a vaccine to a patient who already has an inflammatory kidney or heart event? Why wouldn’t it be obvious that vaccination can make these conditions worse? With an understanding of the above and the absence of placebo-controlled, long-term follow up studies, we cannot reassure people that vaccines will not create or exacerbate an autoimmune disease.  Vaccine-induced acute autoimmune reactions including Guillain-Barre syndrome, thrombotic thrombocytopenic purpura, vasculitis and nephritis[6] are well-described in the medical literature and often listed on vaccine package inserts. If patients were followed longer and if doctors took a more accurate vaccine administration history (of the vaccines given before the new medical problems occur), more vaccine-associated damage would become obvious.

“The rarity and subacute presentation of post-vaccination autoimmune phenomena means that ascertaining causality between these events can be difficult. Moreover, the latency period between vaccination and autoimmunity ranges from days to years.”[7]

A granuloma is a circumscribed nodular inflammation. Granulomas have a typical pattern when examined under a microscope and contain macrophage cells, lymphocytes, neutrophils, and eosinophils (allergy-related immune cells). Granulomas can be caused by a variety of biologic, chemical and physical irritants of tissue.

Some idiopathic (no known cause) renal diseases are granulomatous in nature, and may be caused by an allergic reaction.[8] Patients with granulomatous diseases often present with renal failure and can have allergic manifestations.[9] No cause is ever found for half[10] of all granulomatous interstitial nephritis – a specific granulomatous condition. Aluminum in vaccines is a documented cause of granuloma formation[11], and there is no certainty that aluminum in vaccines is not the cause of many occult or idiopathic kidney problems.  Aluminum is in the following vaccines: DTP, DTaP, some Hib, Pneumococcal conjugate vaccine, Hepatitis B, all combination DTaP/Hib,Tdap or Hepatitis B vaccines, Hepatitis A, HPV, Anthrax and Rabies vaccines.  Can patients be assured that their renal interstitial granulomatous or autoimmune illness is not due to an allergic reaction to a previous vaccination?  Or that they will not develop an atypical allergy to a vaccine component?  The answer, of course, is no.

Here is a partial list of diseases that are “granulomatous,” involve the kidney and more frequently than not, the underlying cause is never known:

*Wegener’s granulomatosis

*Churg-Strauss disease

*Sarcoidosis

*Granulomatous interstitial nephritis

These diagnoses often carry very poor prognoses, and their treatments are very unpleasant and dangerous.  Given the likelihood that vaccines can cause disease in vulnerable patients it is impossible to predict safety across the board, and it is even more difficult to know which patients will suffer the consequences of a vaccine.  The risk-benefit ratio is not necessarily one of favor for vaccination, and our inflamed kidney patients should not be reassured that the vaccine is necessary and safe. Most people would rather choose getting the flu with the miniscule risk of its complications, than develop a vaccine-induced kidney ailment. But for an unidentifiable part of the population this choice cannot be made.  Vaccination is like a game of roulette.  Some people seem to tolerate it (at least for the first few weeks, and thereafter nobody knows) while others could become case reports in medical literature.

Medical Center Experience

I witnessed multiple patients who were stable for years with chronic kidney disease (CKD) deteriorate or relapse rapidly after the flu and/or pneumonia vaccines.  Other doctors just assume that deterioration is what you expect in a person with chronic disease, so when they see it, they don’t connect it with a vaccine.  Yet given how often it happens, if doctors asked questions about vaccines when renal patients suddenly and rapidly decline, and saw that it happens repeatedly, you would think that they would make the link.  But they don’t. It is a mysteriously huge blind spot.

In the Winter of 2009, I treated multiple adult patients who required dialysis after receiving both seasonal and H1N1 vaccines and/or pneumonia vaccines. No other cause for their renal failure could be identified. Some patients stated that they became ill after their flu shot.  Two of these patients died and one remained on dialysis.

On the other hand no patients were dialyzed, in my eleven years of service at this hospital, simply after a case of influenza.  We can see patients develop renal failure during flu-like illnesses – but almost exclusively only if they are prescribed and take large doses of NSAID pain medicine(e.g., ibuprophen), Angiotensin-Converting Enzyme Inhibitors (blood pressure drugs), Angiotensin Receptor Blockers, and/or they were severely volume depleted (dehydrated).

When recently-vaccinated people present to the doctor with acute kidney failure, have not taken any other nephrotoxin, and have no other cause for the kidney failure, the vaccine must be seriously considered as having precipitated the problem. Yet physicians will go out of their way to deny the vaccine as culprit even after they fail to find any other underlying cause. They have no problem admitting that other drugs cause kidney disease, but seem to have a reflex to deny a vaccine as problematic.  Could this be from the sound-bites they have heard over and over  - about vaccines being safe?

The CDC recommendations:[12]

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