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Abstract: PO0114

New Diagnosis of Glomerulonephritis and Relapse of Prior Glomerulonephritis Post mRNA COVID-19 Vaccination

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Klomjit, Nattawat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Zoghby, Ziad, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction

Messenger RNA COVID-19 vaccine is more effective than traditional vaccines due to superior immune activation. However, the impact of mRNA COVID-19 vaccine on glomerulonephritis (GN) is limited. We report 4 cases of patients who developed new or had relapse of GN post vaccination.

Case Description

Case 1: A 43-year-old male with prior COVID-19 infection and baseline serum creatinine (SCr) of 1.2 mg/dl received Moderna vaccine 9 months after recovering from COVID-19 infection. Two weeks after the 1st dose, SCr increased to 2.5 mg/dl. He received 2nd dose 2 weeks later and SCr 3 days after was 2.7 mg/dl. Urinalysis (UA) showed 21-30 RBC/hpf and 24 hr urine protein (UP) was 14.4 g/d. A kidney biopsy revealed IgAN with moderate interstitial nephritis. He was treated with prednisone and ramipril.
Case 2: A 66-year-old male with atrial fibrillation with baseline SCr 1.1 mg/dl received 1st dose of Moderna vaccine and two weeks later SCr was 1.5 mg/dl. Eight weeks after the 2nd dose, SCr was 2.4 mg/dl. UA showed 51-100 RBC/hpf and 24 hr UP 1.2 g/d. A kidney biopsy revealed IgAN with acute tubular injury and RBC casts. He was treated conservatively.
Case 3: A 29-year-old female with minimal change disease who had been in remission for 2 years, received 2 doses of Pfizer vaccine. Three weeks after the 2nd dose, she developed leg edema with albumin 2.2 g/dl, 24 hr UP 10 g/d, and SCr 0.6 mg/dl. A repeat kidney biopsy showed focal segmental glomerulosclerosis, tip variant. She was treated with prednisone and tacrolimus.
Case 4: A 39-year-old male with PLA2R+ membranous nephropathy who was in remission and off immunosuppressive therapy for 1.5 years received 2 doses of Pfizer vaccine. Two weeks after the 2nd dose, he developed leg edema with SCr 1.1 mg/dl, albumin 2.0 g/dl, and 24 hr UP 8.7 g/d. Tacrolimus was re-initiated.

Discussion

New cases and relapse of GN can present shortly after mRNA COVID-19 vaccination. Messenger RNA COVID-19 vaccine may be associated with reactivation of known glomerulonephritis or unmask presence of previously undiagnosed GN such as IgAN possibly due to potent immune activation. However, mechanism remains unknown and additional studies are needed.