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Abstract: SA-PO667

New Onset Anti-GBM Glomerulonephritis on a Background of IgA Nephropathy Post-SARS-CoV-2 Vaccination: A Double Hit Phenomenon?

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Riaz, Ramsha, Jersey City Medical Center, Jersey City, New Jersey, United States
  • Haddad, Danny, Jersey City Medical Center, Jersey City, New Jersey, United States
  • Sansone, Marissa M., Jersey City Medical Center, Jersey City, New Jersey, United States
  • Marian, Valentin, Jersey City Medical Center, Jersey City, New Jersey, United States
  • Jain, Deepika, Jersey City Medical Center, Jersey City, New Jersey, United States
Introduction

Anti–glomerular basement membrane (anti-GBM) nephritis is a rare, but potentially fatal pathology that occurs due to development of IgG autoantibodies against an autoantigen expressed in the basement membrane of kidneys. We present a case of anti-GBM nephritis as an uncommon immune-mediated adverse effect post mRNA Covid-19 vaccination.

Case Description

This is a 41-year-old South Asian female with a history of hypothyroidism, who was tested positive for Covid-19 in April 2021. Post-covid, she received the Pfizer-SARS-CoV vaccine in June and July 2021. Few weeks later, she presented with anemia to her primary care physician, and a couple of months after, a urinalysis revealed significant microscopic hematuria and proteinuria. Further workup revealed a blood urea nitrogen (BUN) of 70 mg/dL and serum creatinine of 9.8 mg/dL which subsequently led to hospitalization for workup of acute kidney injury. Her labs were significant for hemoglobin 6.8 g/dL, BUN/Creatinine 81/10.13 mg/dL, potassium of 5.4, metabolic acidosis (HCO3 16mmol/L), and a urinalysis showing >50 red blood cells (RBCs) per high power field (HPF) with a protein of 300 mg/dL and 24-hour protein excretion of 5.7 g/dL. Complete review of systems was unremarkable with no signs of extrarenal manifestations and negative chest imaging. Immunological workup was negative except for elevated anti-GBM titer at 4.6 (normal <1) and elevated IgG and IgA serum proteins. A renal biopsy was performed to confirm the diagnosis, which showed acute anti-GBM nephritis - crescentic glomerulonephritis with 2-3+ linear IgG staining with incidental mesangial IgA deposits. She was initiated on IV pulse steroids, plasma exchange therapy, and IV Cyclophosphamide. Renal function gradually improved on this treatment regimen.

Discussion

The occurrence of anti-GBM nephritis with concomitant IgA nephropathy post-SARS-CoV-2 mRNA vaccination has been rarely reported in literature. The etiology remains speculative; however, these cases highlight the need to exercise vigilance in patients presenting with symptoms or lab findings suggesting acute kidney injury with a preceding history of recent vaccination. Early identification and intervention may prevent progression of disease.