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Kidney Week

Abstract: PO0113

A Biopsy-Confirmed Case of IgA Nephropathy Flare-Up with Gross Hematuria and AKI Following SARS-CoV-2 Vaccination Successfully Treated with Steroid Therapy

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Watanabe, Shota, University Hospitals, Cleveland, Ohio, United States
  • Zheng, Shuling, University Hospitals, Cleveland, Ohio, United States
  • Rashidi, Arash, University Hospitals, Cleveland, Ohio, United States
Introduction

The flare of immune-mediated disease (IMDs) following SARS-CoV-2 vaccination is a rare adverse event following immunization (AEFI). A few cases of suspected IgA nephropathy (IgAN) flare-up, causing gross hematuria without an increase in Cr, have been reported, and they all resolved without treatment. Here we report a biopsy-confirmed case of IgAN flare-up with AKI following mRNA-1273 vaccination, which was successfully treated with steroid therapy.

Case Description

A 54-year-old female with history of IgAN after strep throat infection that was diagnosed with renal biopsy in 2006. Other significant co-morbidity includes obesity (BMI 31.6), hypertension, and GERD. No prior documented infection with COVID-19. She was on enalapril 20mg daily, hydrochlorothiazide 12.5mg daily, and propranolol 120mg daily. Her baseline creatinine level was 1.2. Urinalysis was positive for 2+ protein, 3+ blood, and RBC 15 /HPF. The total urine protein to Cr ratio was 1.03. Two days after receiving the second Moderna mRNA-1273 vaccine, she developed gross hematuria, which resolved in 2 days. Follow-up Cr increased to 3.04 one week after receiving the second dose of vaccine. The urinalysis showed 1+ protein, 3+ blood, RBC 50/ HPF. The total urine protein to Cr ratio was 0.67. The renal ultrasound was unremarkable. Repeat kidney biopsy showed IgA mesangial deposition, focal segmental and focal global glomerulosclerosis, mild interstitial fibrosis and tubular atrophy, and mild arteriolar hyalinosis. The patient was started on prednisone 60mg daily. Shortly after she was started on prednisone, Cr level started getting better. In 3 weeks Cr level was down to 1.7.

Discussion

This is the first reported case of biopsy-proven IgAN flare-up after SARS-CoV-2 vaccination that caused AKI. Corticosteroid is an effective treatment, promptly improving Cr. IgAN exacerbation after SARs-Cov-2 vaccination should be closely monitored for frequency and consequence to further elucidate AEFI of the novel vaccine.