Sex: M
Vaccine: COVID19
Symptoms: Glomerulonephritis membranous, Inflammation, Protein urine, Urine protein/creatinine ratio
Clinical narrative: Membranous Nephropathy and Collapsing Focal Segmental Glomerulosclerosis; Membranous Nephropathy and Collapsing Focal Segmental Glomerulosclerosis; interstitial inflammation after receiving COVID-19 mRNA vaccination; This is a literature report for the following literature source(s).  A 36-year-old male patient received COVID-19 Vaccine - Manufacturer Unknown, as dose 2, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "nephrotic syndrome" (unspecified if ongoing). The patient's concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (DOSE 1; MANUFACTURER UNKNOWN), for COVID-19 immunisation. The following information was reported: GLOMERULONEPHRITIS MEMBRANOUS (medically significant), FOCAL SEGMENTAL GLOMERULOSCLEROSIS (medically significant), all with latency 2 months after the suspect product(s) administration, outcome "recovered" and all described as "Membranous Nephropathy and Collapsing Focal Segmental Glomerulosclerosis"; INFLAMMATION (medically significant), 2 months after the suspect product(s) administration, outcome "recovered", described as "interstitial inflammation after receiving COVID-19 mRNA vaccination". The patient underwent the following laboratory tests and procedures: Antibody test: 108, notes: Unit: Ru/mL; 10, notes: 6 months after his treatment, Unit: Ru/mL; Biopsy kidney: showed membranous glomerulopathy Stage II-III with, notes: frequent segmental sclerosis with collapsing features as well as severe interstitial inflammation; Blood albumin: 1.6 g/dl; 3.1 g/dl, notes: 6 months after his treatment; Blood creatinine: 0.78 mg/dl, notes: After 11 months; Protein urine: greater than 15 grams of protein; Urine protein/creatinine ratio: 6.1, notes: Unit: g/g. Therapeutic measures were taken as a result of glomerulonephritis membranous, focal segmental glomerulosclerosis, inflammation.  Clinical information: The patient was referred to our clinic for nephrotic syndrome. He developed symptoms of lower extremity edema and fatigue two months after receiving the second dose of an mRNA COVID-19 vaccination. He did not seek medical care at that time. After 11 months he had laboratory studies that showed a serum creatinine of 0.78 mg/dL, serum albumin of 1.6 g/dL, PLA2R antibody titer of 108 Ru/ mL, and 24-hour urine with greater than 15 grams of protein. A kidney biopsy showed membranous glomerulopathy Stage II-III with frequent segmental sclerosis with collapsing features as well as severe interstitial inflammation. He was treated with ACE-I, statin, and two infusions of 1-gram Rituximab given two weeks apart. 6 months after his treatment, his serum albumin was 3.1 g/dL, PLA2R antibody titer was 10 RU/mL, and urine protein to creatinine ratio was 6.1 g/g and his lower extremity edema and fatigue markedly improved. Discussion(s): This case illustrates an unusual combination of membranous nephropathy, collapsing FSGS and interstitial inflammation after receiving COVID-19 mRNA vaccination with partial response to Rituximab at 6 months. Membranous nephropathy and FSGS have been reported after COVID-19 vaccines or infection, but the combination is rarely seen in the literature. This case emphasizes the need for awareness of the diversity of glomerulopathies associated with the COVID-19mRNA vaccination.; Sender's Comments: Based on the information available, the causal relationship between the reported events and suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate