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Abstract: FR-PO612

Isolated Anti-GBM Disease and COVID-19 Vaccination

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Baker, Atlee, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Khan, Maheen, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Vatanapradith, Athip, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Abreo, Kenneth D., LSU Health Shreveport, Shreveport, Louisiana, United States
  • Buffington, Mary A., LSU Health Shreveport, Shreveport, Louisiana, United States
  • Morisetti, Phani Purushotham, LSU Health Shreveport, Shreveport, Louisiana, United States
Introduction

IgA nephropathy is the most reported glomerulonephritis post-COVID vaccination. Other reported cases include atypical anti-GBM nephritis, among others. Treatment consists of immunosuppressants and plasmapheresis with renal replacement therapy. Renal outcomes have varied.

A case is presented of isolated anti-GBM nephritis in a patient whose renal injury occurred weeks after receiving a booster dose of COVID vaccine.

Case Description

A 59-year-old male with recent history of ureteral stones with stent placement, travel history in the last 6 months and use of doxycycline for suspected Lyme's disease in the last 3 months presented to the emergency department for decreased urine output, fevers, and arthralgias. He also received a Pfizer COVID vaccine booster 6 weeks ago. His symptoms had worsened in the last 2 weeks.

On initial evaluation, he was noted to have stage 3 acute kidney injury (AKI) with creatinine 5.3 mg/dL. Although he had findings of nephrolithiasis, no ureteral obstruction or hydronephrosis were noted on imaging. He received extensive infectious work up which was all negative.

Hemodialysis was initiated on day 7 for metabolic derangements and volume overload. After infectious work up was negative, renal biopsy was perfromed revealing linear IgG deposits. Serum anti-GBM antibodies were positive. Despite receiving plasmapheresis, cyclophosphamide and prednisone, the patient continued to require dialysis and was discharged on home hemodialysis.

Discussion

The development of AKI with systemic symptoms occurred about 6 weeks following his COVID vaccine, longer than previously reported cases. The patient also has a history of nephrolithiasis. At this time, direct association of this patient’s anti-GBM disease with the COVID vaccine is unclear however remains a clinical consideration. The presentation of anti-GBM disease is unique as disease is limited to renal involvement.

Linear reaction to IgG