ABSTRACT
Introduction: Rapid and mass SARS-CoV-2 vaccination has been a pivotal strategy to curb the COVID-19 pandemic. The use of developed mRNA vaccines has provided effective protection against COVID-19 infection. However, few cases of immunemediated reactions, such as de novo/relapsing glomerulonephritis (GN) have been reported. Case Description: A 45-year-old man with no PMH presented with progressive worsening lower extremity edema 1 week after receiving the Janssen vaccine (Ad26. COV.2). He was not taking any prescribed or over the counter medications. His physical exam showed BP of 160/90 mmHg and +2 lower extremity edema. Laboratory studies revealed the following: BUN 97 mg/dL, serum creatinine 6.7 mg/dL (baseline 0.8 mg/ dL), serum albumin 1.8 g/dL and 24-hour urine protein of 6.5 g. Serological workup was negative. A kidney biopsy showed focal areas of segmental glomerulosclerosis (FSGS), associated with endocapillary foam cells and epithelial cell capping, predominantly involving the takeoff point of the proximal tubule (fig 1). The areas of segmental sclerosis herniated into the proximal tubule. Immunofluorescence was negative and electron microscopy revealed diffuse epithelial foot process effacement (fig 2). The patient was diagnosed with tip variant of FSGS and started on oral prednisone 80 mg daily. He required initiation of dialysis and has no evidence of renal recovery to date. Discussion(s): New cases and relapses of GN's can present shortly after mRNA COVID-19 vaccination. IgA nephropathy, FSGS and minimal change disease have been reported. The tip variant of FSGS usually presents as a primary podocytopathy and has the best prognosis among the various forms of FSGS due to its high response to steroid therapy and low risk of progression.