Abstract: SA-PO664
AL Amyloidosis Following Johnson & Johnson COVID-19 Vaccination
Session Information
- Glomerular Diseases: IgA and Complement-Mediated GN
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1302 Glomerular Diseases: Immunology and Inflammation
Authors
- Nimkar, Abhishek, Northwell Health, New Hyde Park, New York, United States
- Pariswala, Tanazul T., Northwell Health, New Hyde Park, New York, United States
- Uppal, Nupur N., Northwell Health, New Hyde Park, New York, United States
Introduction
Amyloidosis is a clinical disorder that results from extracellular tissue deposition of pathogenic, misfolded proteins. Several cases of COVID-19 vaccine associated nephrotic syndrome have been described, here we report a case of AL amyloidosis following Johnson and Johnson (J & J) SARS-CoV-2 vaccine.
Case Description
A 76-year-old Haitian male with no past medical history was evaluated for acute kidney injury (AKI) and lower extremity (LE) swelling. Patient mentioned that he started to notice LE swelling on 13th day after receiving J & J SARS-CoV-2 vaccine, with associated presence of foamy urine and weight gain of 13 lbs since the receipt of the vaccine. He denied any rash, joint pains, change in appetite, use of NSAIDs, PPIs, antibiotics or herbal supplements. Lab work showed serum creatinine (Scr) of 2.26 mg/dl (baseline Scr was 1.19 mg/dl, 2 weeks prior to receiving vaccine), low serum albumin (2.1gm/dl), anemia (Hgb 11.4 gm/dl) and hyperlipidemia. Urine analysis revealed >600 mg/dl proteinuria, 37 RBCs with spot urine total protein/ creatinine ratio (TP/Cr) elevated to 8.6. Serum immunofixation showed IgA lambda band. He was initiated on oral torsemide. Kidney biopsy revealed renal amyloidosis AL type, lambda light chain restricted with extensive glomerular and vascular deposits (26% of glomeruli obliterated by amyloid). Subsequently, bone marrow biopsy also showed lambda chain amyloidosis. Scr peaked to 4.66 mg/dl, albumin was low at 2 gm/dl and spot urine TP/Cr was elevated at 13.3. He was initiated on treatment with Daratumumab + Cyclophosphamide, Bortezomib and Dexamethasone. 8 months into therapy, Scr and spot urine TP/Cr have decreased to 2.6 mg/dl and 2.8 respectively and serum albumin had normalized to 3.6 gm/dl.
Discussion
Vaccination is a recognized trigger for new-onset and relapse of glomerular disease. It appears that our patient had undiagnosed amyloidosis, however the onset of nephrotic syndrome occurred after pt. received the vaccine, likely secondary to enhanced immune response causing the disease to manifest clinically. Further studies are needed to determine whether there is an association or causation between the COVID-19 viral vector vaccines and amyloidosis.