Dr LORNA RADFORD1, Dr PRIANKA PURI1
1Kidney Health Service, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane, Australia
Background
Primary Membranous nephropathy (pMN) is one of the most common causes of nephrotic syndrome in adults. The mRNA Coronavirus disease 2019 (COVID-19) vaccination is a new vaccine that has been one of the most effective public health measures to curb the pandemic. Reports regarding a link between COVID-19 mRNA vaccination and pMN are emerging. We report a case of pMN hypothesised to be trigged by the mRNA COVID-19 vaccination.
Case Report
A 39-year-old male with a history of asthma presented to his GP with peripheral oedema and hypertension. A month prior he had received two doses of the Pfizer-BioNTech mRNA COVID-19 vaccine on 01/09/2021 and 22/09/2021. On presentation a 24hr urine demonstrated protein excretion of 7000mg/24hr, a protein:creatinine ratio (PCR) of 455, and an albumin:creatinine ratio (ACR) of 320, his serum albumin was low (25g/L). A diagnosis of pMN was made on renal biopsy which demonstrated phospholipase A2 receptor (PLA2R) antibody positivity on immunofluorescence with positive serum PLA2R antibody levels at 196 relative units (RU)/ml (<14, negative; >20, positive). His renal function was preserved (eGFR>90), his malignancy screening revealed no abnormalities. He was initially managed conservatively with antiproteinuric therapy and diuretics. Four months later his PLA2R levels were 122RU/ml, and he remained nephrotic. A decision was made to administer rituximab combined with tacrolimus. In light of the pandemic we administered his third vaccine on 15/03/2022 prior to immunosuppression however, this was changed to a protein-based vaccine (Novavax).
Conclusions
We postulate a temporal relationship between mRNA COVID-19 vaccination and pMN. Here we have demonstrated the utility of an alternative vaccine regime, along with a concurrent tacrolimus and rituximab therapy for safe treatment of pMN.
Biography:
Bio to come