Kidney Week

Abstract: TH-PO464

A Case of Primary Membranous Nephropathy (MN) After Booster Injection of the BNT162b2 COVID-19 Vaccine (Pfizer-BioNTech)

Session Information

• Glomerular Diseases: Podocytopathies and Nephrotic Syndromes
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1302 Glomerular Diseases: Immunology and Inflammation

Authors

• Zambrano, Cesar, Mount Sinai Medical Center, Miami Beach, Florida, United States

Cesar Zambrano,

• Azuero, Andres Jose, Mount Sinai Medical Center, Miami Beach, Florida, United States

Andres Jose Azuero,

• Bahmad, Hisham, Mount Sinai Medical Center, Miami Beach, Florida, United States

Hisham Bahmad,

• Layka, Ayman, Mount Sinai Medical Center, Miami Beach, Florida, United States

Ayman Layka,

Introduction

All currently authorized COVID-19 vaccines have proven to be safe, effective and reduce risk of severe illness. Glomerular disease have been reported after administration of COVID-19 messenger RNA (mRNA) vaccines. We report on the development of nephrotic syndrome from Primary Membranous nephropathy after third injection of the BNT162b2 COVID-19 vaccine.

Case Description

34 years old female with no significant past medical history except migraine headaches, presented to the outpatient setting reporting intermittent and gradually progressing lower extremities edema for 3 months; accompany by abdominal and lower back swelling, facial edema and foamy urine. She received her 3^rd dose of COVID-19 vaccine 1-2 weeks before symptoms appearance. On evaluation, she was normotensive, preserved kidney function(Creatinine 0.85 BUN 9 eGFR >60), hypoalbuminemia (Alb 1.1 g/dL), nephrotic-range proteinuria (Spot urine protein 869.9 mg/dL, Urine Creatinine 79.9mg/dL, 24hr Urinary protein excretion estimation 11000mg/g [11g/day]), elevated cholesterol (572mg/dL) and triglycerides (220 mg/dL). She has negative ANA, ANCA, DNA Ds Ab, Hepatitis profile, HIV. Her Anti–phospholipase A2 receptor (anti-PLA2R) antibody came back positive (247 relative units/ml [<14, negative; >20, positive]) She underwent kidney biopsy showing global 3+ Subendothelial electron dense deposits (IgG, C3, Kappa, Lambda), 100 % foot process effacement, IF staining positive for PLA2R, consistent with Primary Membranous Nephropathy Stage II. She was started on High-dose steroids and later switched to Tacrolimus 2mg BID, and received Rituximab x 2 doses with major improvement in symptoms and proteinuria.

Discussion

MN is more common in male in their early 50s. The fact our patient doesn’t fit this category, her temporal association with vaccination and the exclusion of other explanatory factors, supports a potential connection between COVID-19 vaccination and glomerular disease. To our knowledge, this is only the second case reporting association of COVID-19 mRNA vaccine and MN. Together with a report from Relapse MN after vaccination and one case of Minimal Change disease, we highlight the possible role of COVID vaccination causing immune glomerular dysregulation. Further studies are needed to elucidate the early postvaccination immune response mechanism.