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: TH-PO465

Relapsed Membranous Nephropathy After COVID-19 Vaccination

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Rajan, Roy, Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
  • Block, Clay A., Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
  • Kaneko, Thomas M., Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
  • Pettus, Jason R., Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
  • Brant, Elizabeth J., Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
Introduction

De novo and relapsed glomerulonephritis (GN), including membranous nephropathy (MN), have been reported after COVID-19 mRNA-vaccination. We report a case of MN that relapsed following COVID-19 vaccination after 26 years of remission.

Case Description

A 78-year-old man presented with nephrotic syndrome (UPC 8.0). His history was notable for primary MN diagnosed by kidney biopsy in 1994. He was treated with prednisone and ACE inhibitor with full resolution of proteinuria. He received COVID-19 vaccine (mRNA-1273, Moderna) March 3 and April 1, 2021. Between the two doses, he had onset of leg swelling. This was attributed to amlodipine, which was discontinued by his PCP. After the second dose of vaccine, edema progressed to anasarca. Urine protein was 5.73g/day. Two months later, the UPC was 8.0, serum creatinine 0.86 mg/dL, and serum albumin 2.7mg/dL. Anti-PLA2R was positive (24RU/mL, ref. >19RU/mL). Renal biopsy showed recurrent MN, EM stage 3-4, PLA2R1 positive.
Due to regional surge of COVID-19 Omicron variant, immunosuppression was held to administer EvuSheld for COVID-19 prophylaxis. Proteinuria improved initially without intervention (UPC 2.7) but increased again (UPC 4.7) a month later. Rituximab was initiated three months after biopsy resulting in undetectable anti-PLA2R 1 week after treatment, with reduction in UPC to 3.7 and improvement of anasarca 2 weeks after treatment.

Discussion

Onset or relapse of GN after vaccination historically has rarely been reported. There are numerous reports of de novo or relapsed GN after COVID-19 infection, and increasing reports of GN after COVID-19 vaccination with mRNA and traditional vaccine platforms. The pathogenesis of GN in this setting has not been established. Nonspecific immune activation and specific COVID-19-related immune reaction have been postulated. MN related to COVID-19 vaccination, although rarely reported, has been treated with standard immunosuppression with favorable results. Management of MN and other forms of GN will evolve with greater understanding of disease course in the setting of COVID-19 infection and vaccination. Patients with a history of GN, including MN, should be counseled about the possibility of relapse with COVID-19 infection or vaccination, even if their original disease was remote.