Podocytopathy After COVID-19 Vaccine Administration in a Patient With Autosomal Dominant Polycystic Kidney Disease

ABSTRACT

Introduction: Development of vaccines against SARS-COV-2 has resulted in considerable reduction in severe complications and mortality. Several cases of glomerular disease have been recently reported such as Minimal Change disease and Focal Segmental Glomerulosclerosis. We describe a patient with autosomal dominant polycystic kidney disease (ADPKD) who developed nephrotic syndrome, soon after receiving COVID-19 vaccine. Case Description 40-year-old male with history of chronic kidney disease stage-3 due to ADPKD diagnosed 20 years ago. Baseline serum creatinine 2 - 2.5 mg/dl and minimal proteinuria. Other comorbidities include well-controlled type 2 diabetes mellitus and hypertension. Received two doses of Covid-19 vaccine on February 25 and March 24, 2021. He had malaise, myalgia, and fatigue after vaccination. On April 2021, was noted to have 3+ protein on dipstick, no quantification done. In May of 2021 patient presented to hospital with heart failure and ejection fraction of 39% in association with acute coronary syndrome due to ST elevation myocardial infarction, underwent placement of a drug-eluting stent and placement on dual antiplatelet therapy (DAPT). He had 3+ protein on dipstick. In June 2021 developed abdominal pain with hematuria which was attributed to cyst-hemorrhage, underwent decortication of left renal cyst. However, the patient continued having gross hematuria requiring multiple blood transfusions and cessation of DAPT. Patient was admitted to UTSW in September 2021 and was noted to have nephrotic syndrome with proteinuria of 3925 mg, low serum albumin of 2.0 g/ dL and pedal edema concerning for podocytopathy associated with COVID-19 vaccine. Kidney biopsy was deferred due to active bleeding. Patient was empirically started on Prednisone 60mg with rapid taper. At discharge 12 days later, proteinuria was down to 0.6 g/g of creatinine, serum albumin 3.2 g/dL and hematuria resolved. On his last follow up, proteinuria was 0.3 g/g, serum albumin 3.6 g/dL and serum creatinine 2.67 mg/dl. Discussion(s) Millions of mRNA vaccines have been administered since the developement of the COVID-19 vaccine. Proposed mechanisms when mounting a response to the vaccine are toll-like receptors promoting podocyte damage in the glomeuruli. These glomerulpathies once noted have been treated with immunosupression and there has been remission reported.