Sex: M
Vaccine: COVID19, UNK
Symptoms: Asthenia, Biopsy, Blood creatinine, Chromaturia, Glomerulonephritis
Clinical narrative: PAUCI-IMMUNE CRESCENTIC GLOMERULONEPHRITIS / GLOMERULI WITH CELLULAR CRESCENTS; MEMBRANOUS NEPHROPATHY STAGE I/IV WITH PLA2R POSITIVE STAINING; GLOMERULONEPHRITIDES; POSITIVE PLA2R STAINING; NIGHT SWEAT; ORANGE COLORED URINE; GENERALIZED WEAKNESS; A literature report has been received. The report concerning a male patient of Unknown ethnic origin (age 58 years).    The patient's past medical history of treated HIV (undetectable viral load) who presented for evaluation of orange colored urine, night sweats and generalized weakness one week after receiving SARS-CoV-2 vaccine along with influenza vaccine.     Serum creatinine on presentation was 2.54 mg/dL (baseline of 0.89 mg/dL one month prior) and rapidly increased to 6.53 mg/dL within one week. Urinalysis demonstrated 1-4 course granular casts/LPF, >50 RBC/HPF, >600 mg/dL protein with urine protein/creatinine ratio of 2.22. Work-up demonstrated normal complement levels, negative ANA, ANCA, anti-GBM, PLA2R hepatitis panel.     Patient underwent renal biopsy which was consistent with pauci-immune crescentic glomerulonephritis involving 40% of glomeruli with cellular crescents as well as membranous nephropathy stage I/IV with PLA2R positive staining.     Patient was treated with pulse dose steroids along with cyclophosphamide with improvement in renal function. Following finding of positive PLA2R staining on kidney biopsy, patient was later transitioned to rituximab and continued to have improvement in renal function.     We favor a diagnosis of de novo rather than relapsed disease given prior normal kidney function without proteinuria or hematuria. The pathologic features on biopsy suggest an early membranous lesion and cellular crescents and lack of significant tubulointerstitial fibrosis point to a new GN.     We postulate that the added immunologic effect of combined COVID and influenza vaccines may have further provoked these two distinct glomerulonephritides.     Membranous nephropathy with positive PLA2R staining on biopsy as well as pauci-immune crescentic GN have individually been described as rare complications associated with COVID immunization, however never concurrently. While GN associated with vaccines is rare, clinicians should be mindful of the potential risk.    No concomitant products were reported.    The patient received Sars-cov-2 Vaccine (covid-19 vaccine nrvv ad (chadox1 ncov-19)), via intramuscular route, for immunization on an unknown date. The patient received Inlfluenza Vaccine (influenza vaccine), via nasal route, for immunization on an unknown date.     No malfunction has been reported for INLFLUENZA VACCINE.    On an unknown date, the patient experienced pauci-immune crescentic glomerulonephritis / glomeruli with cellular crescents (preferred term: Glomerulonephritis rapidly progressive), membranous nephropathy stage i/iv with pla2r positive staining (preferred term: Glomerulonephritis membranous), glomerulonephritides (preferred term: Glomerulonephritis), positive pla2r staining (preferred term: Phospholipase A2 activity increased), night sweat (preferred term: Night sweats), generalized weakness (preferred term: Asthenia), orange colored urine (preferred term: Chromaturia).     The outcome of the event(s) of pauci-immune crescentic glomerulonephritis / glomeruli with cellular crescents, membranous nephropathy stage i/iv with pla2r positive staining, glomerulonephritides, positive pla2r staining, night sweat, orange colored urine and generalized weakness was unknown.     The following events were considered serious due to important medical event: pauci-immune crescentic glomerulonephritis / glomeruli with cellular crescents, membranous nephropathy stage i/iv with pla2r positive staining, glomerulonephritides and positive pla2r staining. The following events were considered non-serious: night sweat, orange colored urine and generalized weakness.     Laboratory values are available.    Device Information:     Combination Product Report: Yes    Product As Reported: INLFLUENZA VACCINE  Common Device Name: Nasal Spray  Procode: CCQ  Product Role: Suspect  Sender's Comments: Glomerulonephritis rapidly progressive, glomerulonephritis membranous, glomerulonephritis and phospholipase A2 activity increased are not listed events in the data sheet for AZD1222 and Q/LAIV. Underlying HIV could be a directly contributory risk factor for the events. Due to limited information on underlying comorbidities, past medical history and concomitant medications, vaccination dates, circumstances leading to events, details of the events including onset dates and outcomes, risk factors, treatment details, clinical course, status of underlying comorbidities, detailed etiological, diagnostic workup as clinical examination, complete blood workup (including infectious profile, inflammatory markers, renal function test with baseline and peak values, blood sugar levels), imaging studies, urine routine microscopy, the evaluation did not find evidence to suggest a causal relationship between events and suspect products.