Clinical spectrum of gross haematuria following SARS-CoV-2 vaccination with mRNA vaccines.

Background: Novel messenger RNA (mRNA)-based vaccines play an important role in current vaccination campaigns against SARS-CoV-2. They are highly efficacious and generally well tolerated. Vaccination in patients with immune-mediated kidney diseases is recommended. A number of cases with de novo or relapsing glomerulonephritis shortly after vaccine application have been reported, some of which presented with gross haematuria. Methods: We collected 10 cases of macrohaematuria following mRNA-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination at our tertiary care institution and referring centres. Additionally, we pooled all 25 published cases from the literature with ours to analyse their clinical characteristics. Results: Most macrohaematuria episodes (72.2%) began within 2 days after vaccination, the majority after the second dose. In some individuals, repeated episodes occurred after subsequent doses of the same vaccine. A total of 65.7% of patients never had macrohaematuria before. A total of 45.7% were known to suffer from immunoglobulin A nephropathy (IgAN); the rest had no prior renal diagnosis. IgAN was the most frequent new diagnosis, but anti-neutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane disease were also identified. Acute kidney injury (AKI) occurred in 28.6% of patients, with an increase in serum creatinine not meeting Kidney Disease: Improving Global Outcomes AKI criteria in 28.6%. Treatment ranged from conservative management, renin-angiotensin-aldosterone system inhibitors, steroids and cyclophosphamide to plasmapheresis. While renal outcomes were mainly favourable in isolated IgAN, they were poor in patients with additional or isolated small vessel vasculitis. Conclusion: Awareness of gross haematuria after SARS-CoV-2 vaccination is important. Close follow-up and additional work up, particularly in individuals without known underlying kidney disease or worsening renal function, is essential. For patients with vaccine-associated macrohaematuria, an alternative vaccine class might be considered for subsequent vaccinations.

Predatory behaviour and taphonomy of a Jurassic belemnoid coleoid (Diplobelida, Cephalopoda).

We describe four complete specimens of the early squid-like cephalopod Clarkeiteuthis conocauda from the Toarcian Posidonienschiefer (Jurassic) each preserved with the bony fish Leptolepis bronni in its arms. Based on the arrangement of prey and predator, we suggest that the cephalopods caught and killed the fishes while still in well-oxygenated waters and then descended into oxygen-depleted water layers (distraction sinking) where the cephalopod suffocated. This explains the exceptional preservation, for which the Posidonienschiefer is famed. This association raises the question for the hunting behaviour of belemnoid Coleoidea. Using the proportions of soft and skeletal body parts of diplobelids and belemnitids, we estimated their body mass and buoyancy and determined the centres of mass and buoyancy. These two points were very close to each other in belemnitids, implying a low hydrodynamic stability (when ignoring the fins), while in diplobelids, the distance between those centres was greater. This suggests that diplobelids usually assumed an oblique to vertical orientation of the body axis while belemnitids could effortlessly achieve a horizontal orientation of their body. Presuming larger fins were attached to the bigger belemnitid rostra, belemnitids were better swimmers and perhaps pursuit predators while diplobelids rather ambushed their prey.

Iatrogenic nephrocalcinosis with acute renal failure: an underestimated complication after parathyroidectomy?

Hypocalcaemia often occurs in patients after parathyroidectomy (PTX) due to hypoparathyroidism and/or hungry bone syndrome. To avoid hypocalcaemia, patients are substituted with large doses of calcium and vitamin D. Here, we present four patients, who developed acute renal failure with hypercalcaemia and/or histologically confirmed nephrocalcinosis after PTX due to oversubstitution with vitamin D analogues and calcium. As a consequence, serum and urinary calcium should be closely monitored after PTX, and calcium and vitamin D substitution should be continuously adapted to avoid not only hypocalcaemia but also nephrocalcinosis and hypercalcaemic renal failure.