Dr Candice Khor1,2, Dr Kasim Ismail3, Dr Vivienne Lea3, Dr Bruce Cleland1, Dr Govind Narayanan1, Dr Daniela Potter1, 4, 5
1Liverpool Hospital, Liverpool, Australia, 2Prince of Wales Hospital, Randwick, Australia, 3NSW Health Pathology, Liverpool Hospital, Liverpool, Australia, 4University of New South Wales 5University of Western Sydney.
Background:
Coronavirus disease-19 (COVID-19) vaccines have been temporally associated with both de-novo and relapsed glomerulonephritis. We present a series of three patients with de-novo elevated myeloperoxidase (MPO) antibodies within three months of receiving the second ChAdOx1-S (Oxford/Astra Zeneca) vaccine. None had features of ANCA-associated vasculitis (AAV) on renal biopsy.
Case Report:
Three female patients between the ages of 61 and 73 years presented with impaired renal function, new haematoproteinuria, anaemia and hypertension within three months of receiving their second ChAdOx1-S vaccine. Two patients had known, but quiescent, IgA nephropathy and lupus nephritis respectively. The third patient had no prior renal history. Creatinine ranged from 150 to 630micromoles/L, with urine protein to creatinine ratio between 485 to 1140mg/mmol. MPO antibody titres were measured at >222 international unit/ml (IU/ml), >222IU/ml and >80IU/ml. The remainder of the vasculitic screens were negative. All three renal biopsies had no features of AAV. Two cases with prior renal disease demonstrated relapse despite prior bland urinalysis. The third case demonstrated features of focal and segmental glomerulosclerosis. Immunosuppression was used in one case with minimal response. The patient later passed away from an infected perforated diverticulum. The remaining two patients were managed conservatively due to chronic damage.
Conclusion:
There may be a temporal relationship between COVID-19 vaccines and the de-novo development of MPO antibodies without features of AAV on renal biopsy. This case series demonstrated the importance of renal biopsy, especially in those with co-existent renal disease for accurate diagnosis. The decision to treat is dependent on the presence of salvageable kidney tissue and must be balanced with the risk of immunosuppression especially in the elderly.
Biography:
Dr Candice Khor is currently the renal fellow at the Prince of Wales Hospital in Sydney, Australia. She recently completed her renal advanced training. Her clinical and research interests include acute kidney injury, glomerulonephritis and renal transplant.