Abstract: PUB667
Minimal Change Disease Relapse after Influenza Vaccination
Session Information
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Isikalu, Olusola, Medical University of South Carolina, Charleston, South Carolina, United States
- Campbell, Ruth C., Medical University of South Carolina, Charleston, South Carolina, United States
- Pisoni, Roberto, Medical University of South Carolina, Charleston, South Carolina, United States
Background
Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS) accounting for 15% of idiopathic NS cases in adults. It is characterized by severe proteinuria, hypoalbuminemia, and hypercholesterolemia leading to edema. MCD onset and relapse following vaccinations has been described in the literature since 1966, but only few cases due to influenza vaccination are reported.
Methods
We report a case of MCD relapse after influenza virus immunization. Patient was a 45-year-old white woman with MCD diagnosed in December 2014 after presenting with abrupt onset of bilateral hand, facial, and lower extremity edema, and frothy urine. She had no significant past medical or allergy history and no signs of systemic infection. She was normotensive. Urinalysis (UA) showed 3+ protein and urine protein-to-creatinine (UPCR) was 6.5 g/g. Serum albumin was 1.5g/dL, total cholesterol 465 mg/dL, WBC 6.79K/mm3, hemoglobin (Hgb) 14.5 g/dL, platelets 417K/mm3, BUN 20 mg/dL, creatinine 1.0 mg/dL, AST 29IU/L, ALT 20 IUL/L, C3 155mg/dL, and C4 29.3mg/dL. RPR, hepatitis B & C serologies, and ANA were negative. After approximately 2 weeks, UPCR worsened to 12 g/g. A kidney biopsy showed MCD and oral prednisone 1mg/kg daily was started in addition to torsemide 5mg/day and rosuvastatin 5mg/day. Complete remission of proteinuria was documented 2 weeks later and persisted after completing a 6-month course of prednisone. Patient remained in complete remission until October 2016 when, just after receiving influenza vaccine, she developed periorbital edema and frothy urine. She denied recent infections or NSAID use. She was normotensive. Renal and hepatic chemistries were normal with creatinine 0.7 mg/dL except for serum albumin of 3.0 g/dL. UA showed protein 100 mg/dL and 24 hour proteinuria was 1.5 g. Relapse of MCD was attributed to recent influenza vaccination in the absence of other potential triggers of MCD. She was treated with oral prednisone 50mg/day and proteinuria resolved within 21 days.
Conclusion
Our case as well as previous anecdotal reports suggest that influenza vaccination and the resulting stimulation of the immune system may cause MCD. This finding demands further investigation in the pathophysiology of MCD and also requires consideration of further vaccinations in this patient population.