ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO676

C3 Glomerulonephritis After Vector COVID-19 Vaccination: A Case Report

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Angamuthu, Akilandanayaki, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Shaikh, Zahir Ali, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Dissanayake, Imara, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Balasubramanian, Manjula, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Gupta, Saurabh, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
Introduction

Mass vaccinations for coronavirus (COVID-19) are being administered worldwide. Even though vaccine is safe and effective, rare adverse events like thrombosis with thrombocytopenia, myocarditis, Guillain barre syndrome have been reported. Renal adverse events such as IgA nephropathy and minimal change disease are reported as well. We report a case of C3 glomerulonephritis (C3 GN) after Johnson & Johnson (J&J) vector COVID-19 vaccine.

Case Description

84-year-old female with history of hypertension, diabetes, and CKD stage 3 presented with fatigue, shortness of breath, leg swelling and poor oral intake. She had received J&J vector vaccine few weeks prior to presentation. Her baseline creatinine was 1.8. Home medications included amlodipine, aspirin, clonidine, coreg, hydralazine, insulin and protonix. In the emergency department, vitals were normal. She had bilateral lower extremities edema. Her labs showed creatinine 5.4 mg/dl, BUN 42 mg/dl, and CPK 167 IU/L. Urine analysis positive for dysmorphic RBCs. 24-hour urine protein was 820 mg. Hepatitis serologies, Anti-dsDNA, SPEP, UPEP, C-ANCA and PR-3 were negative. Her ANA, P-ANCA and MPO titers were positive. Her C3 was low. C4 was normal.
Renal biopsy revealed C3 dominant glomerulonephritis with crescents and moderate interstitial fibrosis. C4d was negative. Hydralazine was discontinued. With worsening renal parameters, she was initiated on hemodialysis. Trial of Steroids and CellCept did not show any response and she remains on hemodialysis.

Discussion

The C3 glomerulopathies are a group of rare kidney diseases characterized by complement dysregulation occurring in the glomerular microenvironment, which results in prominent complement C3 deposition. Most patients are treated with steroids in combination with either cyclophosphamide or Mycophenolate mofetil. Rituximab has been used in some case reports.
To our knowledge, this is the first reported case of C3 GN after receiving the COVID-19 vaccine. In our case, the temporal association suggests an immune response to vaccine as a potential trigger.
1. Lebedev L. and Wechsler A. Minimal change disease following the Pfizer-BioNTech COVID-19 vaccine. Am J Kidney Dis. 2021; 78:142–145.
2. Peggy Perrin and Nicolas Bouvier. Gross hematuria following SARS-CoV-2 vaccination in patients with IgA nephropathy, Kidney Int. 2021 Aug; 100(2): 466–468.