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Abstract: FR-PO037

A Case of Idiopathic Immune-Complex Mediated Glomerulonephritis Following Moderna COVID-19 Vaccination

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Obata, Shota, Shonan Kamakura Sogo Byoin, Kamakura, Kanagawa, Japan
  • Ishioka, Kunihiro, Shonan Kamakura Sogo Byoin, Kamakura, Kanagawa, Japan
  • Hidaka, Sumi, Shonan Kamakura Sogo Byoin, Kamakura, Kanagawa, Japan
  • Yanai, Mitsuru, Sapporo Tokushukai Byoin, Sapporo, Hokkaido, Japan
  • Kobayashi, Shuzo, Shonan Kamakura Sogo Byoin, Kamakura, Kanagawa, Japan
Introduction

mRNA vaccines for COVID-19 have been used worldwide, and a small number of cases have been reported in which mRNA vaccines may have triggered glomerulonephrites such as IgA nephritis, ANCA-associated vasculitis, or MCNS. This is the first case of immuno-complex mediated glomerulonephritis (ICGN) following mRNA vaccination, and we investigated the case including abnormalities in complement regulation.

Case Description

A 71-year-old female with hypertension was referred to our nephrology department with proteinuria and microscopic hematuria. She had had microscopic hematuria and had been examined by urologists, but no apparent abnormality was found. She had received the Moderna COVID-19 vaccine a week before noticing leg swelling. At admission, her vital signs were normal except for her blood pressure of 165/116. She has pitting edema in her lower legs. Lab data revealed serum creatinine of 0.94mg/dL, urinary protein of 1.5g/day, and urine blood of 1+. There was no evidence of hypocomplementemia or various autoantibodies. On day 2, she underwent a renal biopsy showing enlarged mesangial matrix and hyperplasia of mesangial cells with endocapillary proliferation in all glomeruli. GBM duplication and subendothelial and subepithelial electron dense deposits were observed with prominent intracellular proliferation. IF showed peripheral and mesangial deposits of IgG, C3, and C1q, with IgG predominance, suggesting ICGN secondary to infection-related glomerulonephritis. However, the investigation did not detect any etiology of ICGN. She received methyl prednisone of 1000 mg IV for 3 days followed by prednisone of 40 mg daily. She responded to the treatment and was discharged with no hematuria and decreased proteinuria of 0.62 g/day.

Discussion

We have experienced idiopathic ICGN following the Moderna COVID-19 vaccine. Cases with MPGN pattern injury are classified as hematologic, infection-related, collagen disease, or complement dysregulation, and idiopathic cases are considered to be rare. Since this case has mild hematuria prior to vaccination, we hypothesize that the vaccine exacerbates her glomerulonephritis or may affect complement regulation. Therefore we examine the patient's complement regulation genes and also the literature on the possibility of vaccines affecting complement dysregulation.