Glomerulonephritis after Alemtuzumab Treatment for Multiple Sclerosis: A Report of Two Cases.

Introduction: Alemtuzumab, a humanized monoclonal antibody indicated for the treatment of adult patients with active relapsing-remitting multiple sclerosis (MS), has been associated with increased risk of autoimmune adverse events, including thyroid disorders, immune thrombocytopenia, and renal diseases. Renal immune-mediated adverse events, which have been reported in 0.3% of patients treated with alemtuzumab in MS clinical trials, typically occur within 39 months after the last drug administration. However, no consensus has been reached regarding the management of patients who develop glomerulonephritis after treatment with alemtuzumab. Case Presentation: We report the cases of two young adults with MS who developed biopsy-proven severe glomerulonephritis after alemtuzumab treatment. Both patients, including a 32-year-old female patient who developed membranous nephropathy and a 31-year-old male who developed drug-induced podocytopathy, were treated successfully with the calcineurin inhibitor tacrolimus followed by the anti-CD20 antibody rituximab. Conclusion: Regular renal function monitoring is required in patients who may rarely develop glomerulonephritis following treatment with alemtuzumab. There is no clear consensus on case management. In both cases, immunosuppressive therapy, which was necessary due to disease severity, resulted in successful remission, highlighting the potential utility of this approach.

Impact of COVID-19 infection on the dialysis population prospective, observational, nationwide study.

INTRODUCTION: Hemodialysis (HD) patients are at increased risk of severe COVID-19 infection but infection rates vary. Our objectives are to describe COVID-19 positive HD patients' characteristics, infection rates, and factors associated with mortality in HD COVID-19 cases in Kuwait. METHODS: Data on demographics, comorbidities, and treatments received, as well as mortality for HD patients admitted to hospitals for COVID-19, from 1/March to 31/July 2020, prospectively collected and analyzed. RESULTS: A total of 141 infected HD patients were admitted (Mean age 58 ± 16.1; Males 56%), representing 7% of the total HD population and 0.2% of all COVID-19 cases during the study period. Of those 141 infected HD patients, 27 (19%) died, and this represents 6% of total COVID-19-related mortality and 27% of the total HD mortality. In contrast, total covid-19-related mortality of all positive cases was only 0.7%, and total HD mortality during the study period was only 5%. COVID-19-positive HD patients who died were older and 59% were males. However, the differences were not statistically significant. Of the 61 infected HD patients who needed to be switched to continuous kidney replacement therapy (CKRT), 34% died, and of the 29 infected HD patients who needed admission to intensive care, 65% died. CONCLUSION: HD population represents a small fraction of the total population; however, positive HD COVID-19 cases represent a sizable proportion of COVID-19 cases and a significant percentage of total COVID-19-related mortality, and total HD mortality.

Safety of Intravenous Iron in CKD Stage 3-5 Patients Not on Dialysis: A Retrospective Cohort Study.

Background: Iron deficiency is common in chronic kidney disease (CKD) patients not on dialysis (ND). Restoring depleted iron stores through intravenous (IV) route is faster and associated with less side effects. There is conflicting data regarding intravenous iron use and its impact on clinical outcomes in this population. Objective: This study aims at evaluating any negative clinical impact associated with IV iron use in CKD patients at stages (3-5) before dialysis. Design: Retrospective chart review. Setting and Population: Chart analysis of ND CKD 3-5 (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) patients who received IV iron between January 2013 and January 2018 in 3 major hospitals in Kuwait. Methods: Outcomes analyzed were rates of all-cause hospitalizations, infection-related hospitalizations, mortality rates, and eGFR decline over 12 months after IV iron infusion in this population divided into 3 groups according to CKD stage. Results: A total of 738 patients were included in our analysis. Mean initial hemoglobin concentration was 111.5 ± 15.0 g/L in group 1 (CKD 3: eGFR 30-59 mL/min/1.73 m2), 103.6 ± 17.7 g/L in group 2 (CKD 4: eGFR 15-29 mL/min/1.73 m2), and 99.4 ± 14.5 g/L in group 3 (CKD 5: eGFR < 15 mL/min/1.73 m2 but not on dialysis). All-cause hospitalization and infection-related hospitalization were more common among group 3 subjects (adjusted odds ratio =2.12 [95% confidence interval, CI: 1.32-3.41] and 2.02 [95% CI: 1.15-3.55]), respectively. No deaths occurred during 12 months of follow-up. Limitations: Lack of control group, retrospective study. Conclusion: Intravenous iron use in CKD 3-5 ND is generally safe. Higher hospitalization rates in patients with eGFR <30 mL/min are possibly associated with lower baseline hemoglobin, lower baseline eGFR, and higher comorbidity burden, and not related to iron infusion.

Contexte: La carence en fer est fréquente chez les patients atteints d'insuffisance rénale chronique (IRC) qui ne sont pas sous dialyse (ND). Le rétablissement des réserves de fer par voie intraveineuse (IV) est plus rapide et associé à moins d'effets secondaires. Les données sur l'administration du fer par intraveineuse et son incidence sur les résultats cliniques dans cette population demeurent toutefois contradictoires. Objectif: Cette étude vise à évaluer tout effet clinique négatif associé à l'administration de fer IV chez les patients atteints d'IRC de stade 3 à 5 avant la dialyse. Type d'étude: Examen rétrospectif des dossiers médicaux. Cadre et population: Analyse des dossiers médicaux de patients atteints d'IRC de stade 3 à 5 (DFGe < 60 ml/min/1,73 m2) ND ayant reçu du fer IV entre janvier 2013 et janvier 2018 dans trois grands hôpitaux du Koweït. Méthodologie: Les taux d'hospitalisations toutes causes confondues et d'hospitalisations liées à une infection, le taux de mortalité et le déclin du DFGe ont été mesurés sur une période de 12 mois après la perfusion de fer. La population était divisée en trois groupes selon le stade de l'IRC. Résultats: L'analyse porte sur un total de 738 patients. La concentration initiale moyenne d'hémoglobine était de 111,5 ± 15,0 g/L dans le groupe IRC 3 (DFGe: 30-59 ml/min/1,73 m2), de 103,6 ± 17,7 g/L dans le groupe IRC 4 (DFGe: 15-29 ml/min/1,73 m2) et de 99,4 ± 14,5 g/L dans le groupe IRC 5 (DFGe < 15 ml/min/1,73 m2 sans dialyse). Les hospitalisations toutes causes confondues et les hospitalisations liées à une infection étaient plus fréquentes chez les sujets du groupe IRC 3 (rapport de cotes ajusté = 2,12 [IC à 95 %: 1,32-3,41] et 2,02 [IC 95 %: 1,15-3,55] respectivement). Aucun décès n'est survenu pendant les 12 mois de suivi. Limites: Absence de groupe témoin, étude rétrospective. Conclusion: L'administration de fer IV chez les patients atteints d'IRC de stade 3 à 5 ND est généralement sûre. Le taux d'hospitalisation plus élevé observé chez les patients présentant un DFGe < 30 ml/min est probablement attribuable à des mesures initiales plus faibles pour l'hémoglobine et le DFGe, de même qu'à une charge de comorbidité plus élevée, plutôt qu'à la perfusion de fer.