Abstract: PO0108
Focal Segmental Glomerulosclerosis (FSGS) Recurrence After mRNA COVID-19 Vaccine in a Young Adult with Kidney Transplant
Session Information
- COVID-19: Health Systems and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Lopez, Sonya B., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Savant, Jonathan D., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Hewlett, Jennifer, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Galea, Lauren E., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Fulchiero, Rosanna, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Laskin, Benjamin L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- LaRosa, Christopher J., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Viteri, Bernarda, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Introduction
Patient is a 21 year old Hispanic male with history of FSGS 8 years status post deceased donor kidney transplant. Other than one prior FSGS recurrence early post-transplant, which responded to plasmapheresis (PP) and rituximab, he maintained normal allograft function with stable, low level proteinuria on losartan 12.5 mg daily.
Case Description
Routine labs 1 day prior to COVID 19 mRNA vaccine series were stable with serum creatinine (sCr) 0.8 mg/dL, urine protein creatinine ratio (UPCR) 0.42 mg/mg (65 mg/dL of protein), and serum albumin 4.8 g/dL. Thirty-one days after the second COVID 19 vaccine, routine labs were significant for nephrotic range proteinuria with UPCR >6.21 mg/mg (>2500 mg/dL of protein), hypoalbuminemia (1.7 g/dL), and peak sCr of 1.3 mg/dL. Of note, he remained asymptomatic until 2 days prior to labs when noted to have periorbital and lower extremity edema associated with decreased urine output. Allograft biopsy revealed foot process effacement without definitive evidence of segmental sclerosis. Infectious workup including viral studies for SARS-CoV-2 were negative. He received methylprednisolone 1g IV for 3 days, thrice-weekly PP, rituximab 375 mg/m2 weekly x2, and an oral prednisone taper. During week 4 of PP concurrent with prednisone taper, the patient appeared clinically well with noted improvement in labs: UPCR 0.55 mg/mg, sCr 0.57 mg/dL, and serum albumin 3.5 g/dL. He is currently undergoing wean of PP and steroids.
Discussion
While there are isolated reports of new onset or recurrence of proteinuric kidney disease after an mRNA COVID-19 vaccine, to our knowledge, this is the first report of FSGS recurrence in a kidney transplant recipient. Although causality is not proven, the temporal relationship strongly suggests an association between the vaccine and the recurrence. Compared with prior reports, our patient presented somewhat later, ~1 month after dose #2 as compared to within 2 weeks after dose #1. Although the risk-benefit ratio of COVID vaccination for kidney transplant recipients remains favorable and vaccination is encouraged by national clinical guidelines, close monitoring after COVID vaccine for kidney transplant patients at risk for disease recurrence is warranted.