Abstract: PO0110
IgA Nephropathy After Receiving the Pfizer COVID-19 Vaccine: A Case Report
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)
Author
- Roberts, Lisa Lembeck, University of Rochester, Rochester, New York, United States
Introduction
Here, we present a case of IgA nephropathy in a 22-year-old Caucasian woman with no comorbidities and prior COVID positive infection, after receiving the Pfizer vaccine for COVID-19. She initially presented to her primary care physician for an episode of gross hematuria two days after receiving the first Pfizer COVID -19 vaccine.
Case Description
She was asymptomatic for urinary tract infection, neither was she menstruating. Her renal functions were normal with a creatinine of 0.93 mg/dL. Urinalysis showed hematuria with > 50 red blood cells (RBC) per high-power field (HPF) and 2+ protein on the dipstick. She again experienced gross hematuria with > 50 RBC/HPF on urinalysis and proteinuria of 2.23g after receiving the 2nd Pfizer vaccine, at which time she was referred to the Nephrology department for further evaluation.
We examined urine sediment which was significant for dysmorphic RBCs and rare granular casts. A renal biopsy showed that the majority of 14 glomeruli had global sclerosis on light microscopy, a diffuse increase of mesangium, and interstitial fibrosis with tubular atrophy. Immunofluorescence microscopy was positive for Immunoglobulin A (IgA), Lambda light chains, and anti-complement C3 antibodies. Electron microscopy revealed mesangial expansion and cellularity and peri-mesangial electron-dense deposits. These and other findings fit with the Oxford Classification of M1, S1, E0, T0, C0.
Following the biopsy, we prescribed Lisinopril 5 mg daily for control of proteinuria. We did not prescribe glucocorticoids due to the mild nature of the disease and lack of underlying inflammation. The patient continues to do well without symptoms. Her most recent labs show preserved renal function and spot proteinuria reduced to 1.3 g.
Discussion
The current case raises questions about the potential association of IgA Nephropathy with the COVID vaccine. One of several possible mechanisms includes an aberrant mucosal immune response to the initial SARS-COV-2 infection that she contracted in December 2020. This could have then predisposed her to IgA nephropathy after the administration of the vaccine. The virus’ spike protein or other factors may trigger an aberrant mucosal immune IgA response which can then lead to the onset and progression of IgA nephropathy. Further case series are needed to establish a more definitive association of the COVID-19 vaccine with IgA nephropathy.