DR RAZAN ZEIN1,3, DR DAVID WONG2, DR GREG WILSON1,3
1Department of Nephrology, Mater Hospital Brisbane, Brisbane, Australia, 2Department of Pathology, Mater Hospital Brisbane, Brisbane, Australia, 3Faculty of Medicine, The University of Queensland, Brisbane, Australia
Background
SARS-CoV-2 (Covid-19) mRNA vaccines such as the Comirnaty (BioNTech-Pfizer) and Spikevax (Moderna) have recently been associated with the onset of IgA Nephropathy. We describe a case of IgA nephropathy that developed following the administration of a second dose of the Comirnaty Covid-19 vaccine.
Case Report
A 37-year-old man presented to the Emergency Department two days after his second Comirnaty Covid-19 vaccine with a cola-colored urine, 3+ proteinuria on urinalysis, hypertension, and a stage 1 acute kidney injury (serum creatinine of 124umol/L; normal: 60-110). He was provisionally diagnosed with rhabdomyolysis and managed with intravenous fluid with resolution of his hematuria.
Planned follow up showed ongoing microscopic hematuria, proteinuria and persisting abnormal kidney function. A 24-hour urine collection shows 1.8 grams of proteinuria. ANA, ENA, ANCA, dsDNA, anti-GBM were negative. C3/C4 were normal. He proceeded to kidney biopsy which demonstrated mesangial hypercellularity on light microscopy and 2+ granular mesangial reactivity for IgA, kappa and lambda on immunofluorescence consistent with IgA Nephropathy. He was commenced on Irbesartan 150mg daily and 10 mg dapagliflozin. Three months after commencing treatment his proteinuria had worsened and his serum creatinine remained elevated (urine protein/creatinine ratio 297mg/mmol; serum creatinine 126umol/L ). Prednisolone was added to his therapy. One month later, there was a marked improvement in his proteinuria (urine protein/creatinine ratio 182mg/mmol) and normalization of his renal function (serum creatinine 89umol/L). He was continued on a 6-month weaning course of prednisolone.
Conclusion
Covid-19 vaccine induced IgA Nephropathy is an emerging entity that should be considered in patients with new onset hematuria and proteinuria following mRNA covid-19 vaccination. Further studies are needed to confirm the pathophysiology and best management for this condition.
Biography:
Dr Razan Zein is a second year physician trainee in Southside Network of Brisbane. Razan is an aspiring nephrologist and also has a keen interest in research and teaching.