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Abstract: TH-PO1105

Case of Membranous Nephropathy (MN) After COVID-19 Vaccine

Session Information

  • 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)

Authors

  • Jatoi, Tahir Ahmed, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Sasidharan, Sandeep Raja, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Elhawary, Omar Nabil, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Abushawer, Mohammad Waleed, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Agarwal, Sonalika, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Mallappallil, Mary C., SUNY Downstate Health Sciences University, New York City, New York, United States
  • Puri, Isha, SUNY Downstate Health Sciences University, New York City, New York, United States
Introduction

Covid vaccines are considered the best approach to prevent SARS-CoV-2 infection. There are few biopsy proven cases reported of glomerular pathology associated with COVID-19 vaccines. Here we present a case of primary membranous nephropathy (anti-PLA2R positive) that developed after Pfizer-BioNTech COVID-19 vaccine.

Case Description

56 y-o M with history of HTN and recent PE with negative hypercoagulability work up, on Eliquis presented with complaints of leg and orbital edema for 6 weeks. He had similar complaints few months ago and presented to an outside hospital when he was diagnosed with PE. He reported that he first noted swelling in his lower extremities after the first dose of covid vaccine which worsened after he received the second dose. Labs showed a Serum Creatinine of 1.3 mg/dl, urine protein>300, Serum albumin 1.7 mg/dl, HbA1c of 5.8, Spot UPCR was 6.8 g/g and anti-PLA2R titers were 539. Renal biopsy was done which showed positive granular capillary wall staining for PLA2R1 (2+) and mild interstitial fibrosis with tubular atrophy. Immunofluorescence was positive for IgG, C3, Kappa and Lambda light chains. Electron Microscopy showed glomerular subepithelial dense deposits, with slight mesangial expansion and epithelial foot process effacement diagnostic for stage 1 MN and ATN. He was treated with supportive measures initially and later switched to Rituximab infusion for two doses after biopsy confirmed MN. He had poor response and his UPCR remained >10g/d. Tacrolimus was subsequently added for persistent proteinuria but without sufficient response. He was then started on a cyclical corticosteroids and Cyclophosphamide with successful achievement of remission.

Discussion

MN accounts for 20-30% of Nephrotic syndrome cases. Anti-PLA2R antibodies are identified in 70-80% of primary MN cases. Given recent reports of de-novo glomerular diseases after receiving COVID-19 vaccines in depth studies of vaccinated patients are needed to establish a causal relationship.

Biopsy