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Abstract: FR-PO679

Messenger RNA COVID-19 Vaccine-Associated Collapsing Focal and Segmental Glomerulosclerosis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Author

  • Jweehan, Duha A., UConn Health, Farmington, Connecticut, United States
Introduction

A novel coronavirus (SARS-CoV-2) mRNA vaccine was invented as a mitigation strategy to control COVID- 19 pandemic and as a promising approach to reduce the spread of COVID- 19 infection among population worldwide with impressive reduction in new COVID- 19 infection cases. We report a first case of collapsing focal and segmental glomerulosclerosis (FSGS) was diagnosed post-second dose of SARS- CoV-2 Moderna vaccine.

Case Description

A 75-year-old Caucasian female with unremarkable medical history who was admitted anasarca started 6 weeks after receiving the second dose of SARS- CoV-2 Moderna vaccine. She was found to have anuric acute kidney injury,blood pressure 210/110 mmHg. Laboratory results showed serum creatinine 8.2 mg/dl, serum albumin 2.6 g/dl. Urine microscopic showed numerous granular casts and tubular epithelial cells. 24 hr. urinary collection revealed proteinuria of 6.9 g. Transthoracic echocardiogram was normal. Kidneys were normal in size with increased cortical echogenicity on renal ultrasound. Unremarkable comprehensive workup.
Kidney biopsy showed segmental sclerosis with associated hyperplastic visceral epithelial cells with intracytoplasmic protein reabsorption droplets. The associated capillary loops appeared collapsed. Immunofluorescence showed segmental glomerular staining for IgM, C3 and C1q (3+).

Discussion

Several case reports have been published suggesting a temporal association between glomerular disease and relapsing glomerular disease after receiving SARS-CoV-2 RNA (mRNA) vaccines of either Pfizer- Bio-Tech or Moderna mRNA-1273,
SARS-CoV-2 mRNA vaccines generate humoral and cell- mediated immune response by CD4 and CD8 expansion to T helper-based response with production of interferon-gamma, tumor necrosis factor- alpha, interleukin-2 and antibody production predominantly of immunoglobulin G1 and IgG subclass.That suggests cell- mediated immune reaction that may cause podocyte injury or recurrence of glomerular disease. Potential mechanism of podocyte injury post SARS- CoV-2 mRNA vaccine may be triggered by cytokine-medicated response, direct toxic effect or a rapid T cell- medicated immune response and lead to podocytopathy.
Further investigations are needed to establish the causal relationship between SARS-CoV-2 and glomerular injury in susceptible individuals. Increase awareness in that regard might help to expand database of those cases.