COVID-19 in renal transplant recipients and general population: a comparative study of clinical, laboratory, and radiological features, severity, and outcome.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of deaths worldwide. Kidney transplant recipients (KTRs) are a fragile population due to their immunosuppressed status. However, there are limited studies available comparing this population with the general population regarding clinical symptoms, and laboratory and imaging features as well as disease severity and clinical outcomes. METHODS: A total of 24 KTRs and 40 patients from the general population (control group) were enrolled after applying exclusion criteria. Clinical symptoms, laboratory values, and lung involvement patterns in high-resolution computed tomography (HRCT) were compared between KTRs with COVID-19 and their counterparts from the general population. Moreover, the category of disease severity and adverse outcomes such as intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality rate were also compared between these two groups. RESULTS: Hypertension was significantly higher among KTRs. Dyspnea was significantly more among the control group (P = 0.045). There was no significant difference in the rest of clinical symptoms (P > 0.05). There was no significant difference in CT features as well, except pleural effusion, which was more prevalent in the control group. A lower absolute lymphocytic count (ALC) and platelet count were observed in KTRs. Renal transplant recipients (RTRs) had a higher elevation in creatinine level than their counterparts. The ICU admission, MV, duration of hospital stay, and mortality as adverse outcomes were not significantly different between the KTR and control groups. CONCLUSION: In conclusion, there was no significant difference in the severity and risk of adverse outcomes, including MV, ICU admission, and mortality between KTRs under chronic immunosuppression and the control group.

Clinical characteristics and outcome of COVID-19 pneumonia in kidney transplant recipients in Razi hospital, Rasht, Iran.

BACKGROUND: In late December 2019, a novel coronavirus SARS-CoV-2 started to spread around the world in different populations. Its clinical and laboratory characteristics and outcome in kidney transplant recipients are little known. Therefore, we describe 22 kidney transplant recipients with SARS-CoV-2-induced pneumonia. METHODS: All kidney transplant recipients who referred to the Razi Hospital of Rasht with a diagnosis of SARS-CoV-2 infection from February 20 to 19th of April 2020 have been included in this observational study. RESULTS: We present 22 cases of COVID-19 in kidney transplant recipients (median age 52 years [interquartile range 40.75-62.75 years]) and baseline eGFR 60 (mL/min/1.73 m2 ) (44.75-86.75). Patients complained of cough (72.7%), dyspnea (63.6%), fever (68.2%), and chill (72.7%) with greater prevalence. We decreased the dose of immunosuppression and started stress dose of intravenous hydrocortisone or equivalent oral prednisolone. Each patient received antiviral therapy based on the latest updated version of local protocol at the time of admission. CT scan findings in 90.9% of patients showed bilateral multifocal lesions. Acute kidney injury (AKI) was observed in 12 patients during hospitalization. Six patients died after a median of 12 days from admission (IQR, 1-21). CONCLUSIONS: In this small observational study, we observed high AKI occurrence and mortality rate in kidney transplant recipients with COVID-19.

Percutaneous biopsy of kidney; comparison between prone position and sitting position.

INTRODUCTION: Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method. This study aims to describe the author's experience with biopsy of the kidney and to compare the results in sitting position versus prone in terms of the complication rate. MATERIALS AND METHODS: Patients were divided into two groups: prone and sitting position according to the clinician's and patient's preference. Followed by kidney biopsy, a questionnaire was completed. Then, data and the mean number of glomeruli in each group were compared. RESULTS: Apart from sweat, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of glomeruli was not significantly different between two groups. CONCLUSION: In comparison with the prone position, kidney biopsy at sitting position is more comfortable at least for patients who seems couldn't tolerate prone position. We recommend sitting position for kidney biopsy owing to the low side effects rate of this diagnostic technique.