Abstract: PUB250
Acute Granulomatous Interstitial Nephritis Post-COVID-19 Vaccination
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Zhang, Chi, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Zhang, Grace Joyce, The University of British Columbia, Vancouver, British Columbia, Canada
- McRae, Susanna A., The University of British Columbia, Vancouver, British Columbia, Canada
- Riazy, Maziar, The University of British Columbia, Vancouver, British Columbia, Canada
- Bissonnette, Mei Lin, The University of British Columbia, Vancouver, British Columbia, Canada
Introduction
Various kidney diseases were described with association to Vaccination. In this case, we have identifed a patient with acute granulomatous interstitial nephritis likely associated with Moderna Covid-19 vaccine.
Case Description
56 year old Caucasian male with history of dyslipidemia, erectile dysfunction and alopecia was seen with new onset renal failure discovered Jan. 2023 3 months post Covid-19 vaccination. He had 4 doses overall and last dose was given in Oct. 2022. His eGFR was 70cc/min in Feb 2022 before plummeting to 8cc per min in Jan. 2023, which prompted referral. Renal biopsy was done Jan. 2023 and showed acute granulomatous interstitial nephritis. Serological work up were negative. Differentials: sarcoidosis ( chest CT neg),TB, fungal infection (culture neg) , pauci-immune glomerulonephrritis and drug (finasteride) induced reaction was considered unlikely. On Jan.25, 2023 he was started high dose prednisone treatment 60 mg per day and tapered down about 5 mg per week. And his eGFR started to improve to 40cc/min. Second renal biopsy showed disappearance of granulomatas lesion.Upon stopping prednisone, his eGFR started to drop again to 20 cc per min. He had third renal biopsy which showed recurrence of multiple large non-necrotizing granulomas lesion involving most of the sampled renal tissue. There are very prominent eosinophils as well. He responded again to prednisone and was switched to and maintained on cellcept.Althought the course is somewhat atypical, association with Moderna vaccination is more likely than other causes. Since May 2024 he has been on Cellcept 1 g bid with fairly good response eGFR went up to 38 cc/min.
Discussion
Previous studies have shown association between Covid Vaccination and acute interstitial nephritis. We have shown in this abstract a case with AIN and non-necrotizing granulomatas lesion. As reported previously, there is a reasonable response to large dose steroids followed by Cellcept.
Diffuse acute granulomas intersitial nephritis H&E stain. 200x