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Abstract: FR-PO049

A Case of Collapsing Focal Segmental Glomerulosclerosis in Post-mRNA COVID-19 Vaccination

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Khan, Shabtab, Emory University School of Medicine, Atlanta, Georgia, United States
  • Caberto, Sheryl C., Emory University School of Medicine, Atlanta, Georgia, United States
Introduction

The association of collapsing Focal Segmental Glomerulosclerosis (FSGS) and mRNA COVID-19 vaccine has been reported. The APOL1 genotype is present in about 75% of African descendants with FSGS. This increases the rates of FSGS as well as HIV-associated nephropathy. We present a case of African-American male with Human Immunodeficiency Virus (HIV) who developed collapsing FSGS after mRNA covid vaccination.

Case Description

A 24-year-old male with history of well-controlled HIV on Biktarvy was referred to nephrology for acute kidney injury (AKI) with nephrotic-range proteinuria. Outpatient workup for nephrotic syndrome was unrevealing. Two months prior to AKI, patient received Moderna mRNA COVID-19 vaccine. Renal function worsened with creatinine of 1.6 mg/dL from 1.3 mg/dL with 6 grams of proteinuria. Renal biopsy was done which revealed collapsing FSGS with 10% interstitial fibrosis and tubular atrophy. This was unlikely due to HIV. Treatment was started with Methylprednisolone, Mycophenolate and Lisinopril. A booster COVID-19 vaccine was not recommended.

Discussion

Proteinuric renal disease is common in patients with history of HIV, but for a patient with well-controlled HIV, other causes of glomerular diseases must be ruled out. We present this case to consider mRNA COVID-19 vaccine as a potential cause of nephrotic syndrome. Glomerular diseases have been reported in temporal association with Moderna and Pfizer BioNTech vaccines. In a case series of 29 biopsy proven glomerular disease that were documented within 1 month of a covid vaccination, 27 out of 29 cases were new onset glomerular diseases. The most common glomerular disease was IgA nephropathy. This a case of collapsing glomerulopathy in relationship with COVID- 19 vaccine. Collapsing FSGS has been commonly reported as a cause of AKI in COVID-19, but in our case, we have a patient with collapsing FSGS in the setting of COVID-19 mRNA vaccination.

It is unclear of what mechanism attributed to FSGS, but it is possible to consider an inflammatory response against the spike protein as a ‘second hit’ phenomenon to susceptible individuals, such as African Americans with APOL-1 risk alleles or HIV. This is a potential adverse effect that must be considered after mRNA covid vaccination.