A Case of Membranous Nephropathy and Collapsing Focal Segmental Glomerulosclerosis After COVID-19 mRNA Vaccination
- COVID-19 - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
- Rudy, Mark, University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Sawaya, B. Peter Emile, University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Ahmed, Sadiq, University of Kentucky College of Medicine, Lexington, Kentucky, United States
The mRNA COVID-19 vaccines have been an effective method for combating the deadly COVID-19 virus. In the literature, there are case reports of glomerulopathies developing after vaccination. It is important to be aware of this potential association to allow for prompt investigation and treatment. We highlight a case of combined membranous nephropathy and collapsing focal segmental glomerulosclerosis in a 36-year-old male after mRNA COVID-19 vaccination.
A 36-year-old white male was referred to our clinic for nephrotic syndrome. He developed symptoms of lower extremity edema and fatigue two months after receiving the second dose of an mRNA COVID-19 vaccination. He did not seek medical care at that time. After 11 months he had laboratory studies that showed a serum creatinine of 0.78 mg/dL, serum albumin of 1.6 g/dL, PLA2R antibody titer of 108 Ru/mL, and 24-hour urine with > 15 grams of protein. A kidney biopsy showed membranous glomerulopathy Stage II-III with frequent segmental sclerosis with collapsing features as well as severe interstitial inflammation. He was treated with ACE-I, statin, and two infusions of 1-gram Rituximab given two weeks apart. 6 months after his treatment, his serum albumin was 3.1 g/dL, PLA2R antibody titer was 10 RU/mL, and urine protein to creatinine ratio was 6.1 g/g and his lower extremity edema and fatigue markedly improved.
This case illustrates an unusual combination of membranous nephropathy, collapsing FSGS and interstitial inflammation after receiving COVID-19 mRNA vaccination with partial response to Rituximab at 6 months. Membranous nephropathy and FSGS have been reported after COVID-19 vaccines or infection, but the combination is rarely seen in the literature. This case emphasizes the need for awareness of the diversity of glomerulopathies associated with the COVID-19 mRNA vaccination.