An unusual ureteral dynamic obstruction in a kidney transplant patient.

INTRODUCTION: Ureteral complications are common in kidney transplanted patients; approximately 2.6-15% of patients develop ureteral obstruction/stenosis at some time after surgery, which is one of the most frequent urologic complications. Inguinal herniation of the neoureter is a rare complication but it must be taken into account. CLINICAL REPORT: We describe the case of a 78-years old male kidney transplanted patient (2004), who was admitted at the emergency room due to abdominal pain and with evidence of acute kidney injury. The ultrasound showed hydronephrosis (grade III) along with ureteral dilatation which ended with an image compatible with a kinking, that was confirmed at the TC and showed that the kneeling was in the right inguinal canal. It was possible, with a manual hernia reduction manoeuvre, to readjust the kneeling of the neoureter resolving the condition temporarily. The patient underwent underwent surgical hernia repair with no complication and complete recovery of renal function. CONCLUSIONS: When ureter obstruction of the transplanted kidney occurs, it is crucial to resolve the obstruction as soon as possible in order to preserve kidney function. Hernioplastic is an effective way to treat ureter obstruction when it is caused by its herniation.

[SARS-CoV-2 mRNA-based vaccine in hemodialysis patients: a single center-experience].

Hemodialysis patients have an increased risk of severe complications when infected with SARS-CoV-2. The introduction of the SARS-CoV-2 vaccine represented an important progress in limiting severe forms of the disease. The focus of our study is the detection of the antibody titer in chronic hemodialysis patients vaccinated with the mRNA vaccine BNT162b2 (Comirnaty, Pfizer-BioNTech). The antibody titers were measured in 57 hemodialysis patients, vaccinated with 3 doses according to ministerial criteria, by ElectroChemiLuminescence ImmunoAssay (ECLIA). The response was defined as an antibody titer above the dosable level > 0,8 UI/ml. A good antibody response was defined as titer > 250 UI/ml. Infections with SARS-CoV-2 and adverse effects to the vaccine were recorded. Our study showed in 93% of the hemodialysis patients a dosable antibody response after the second dose of the vaccine. After the third dose of the vaccine, 100% of the hemodialysis patients reached a dosable antibody titer. The vaccine proved to be safe, no serious adverse events were observed. After the third dose, SARS-CoV-2 infections were still observed, but with reduced severity. A vaccination course against SARS-CoV-2 infection with three doses of BNT162b2 in the dialysis patient is associated with a good immune response and protects against severe infections.

[EBV-ASSOCIATED PNEUMONIA IN PATIENT WITH GRANULOMATOSIS WITH POLYANGIITIS (GPA) IN IMMUNOSOPPRESSIVE THERAPY TREATED WITH ACICLOVIR].

Granulomatosis polyangiitis (GPA) is an ANCA-related vasculitis (AAV) whose clinical manifestations mainly concern the respiratory tract (upper and lower) and the kidney. The treatment of GPA (as well as other AAV) includes the use of immunosuppressive drugs with numerous side effects; the most frequent complications are infectious and neoplastic. GPA frequently relapses. Epstein Barr Virus (EBV) is a ubiquitous virus; it is estimated that about 90% of the world's population has BEEN EXPOSED TO with this pathogen and has subsequently developed a latent infection. Under certain conditions including immunosuppression EBV may reactivate. We report the clinical case of a 67-year-old woman who presented with GPA involving the upper respiratory tract and renal failure with the need for hemodialysis treatment. The fourth month of induction therapy with cyclophosphamide and methylprednisone she presented with dyspnea and respiratory failure. After excluding pulmonary embolism and heart failure, a series of investigations including high resolution tomography and fibroscopy with broncoalveolar lavage (BAL) were performed which excluded recurrence of pulmonary vasculitis including alveolar haemorrhage A BAL demonstrated EBV-DNA. On this basis EBV pneumonia was diagnosed, and antiviral therapy with acyclovir was begun, followed by clinical and radiological improvement. In patients with GPA treated with immunosuppressive drugs pulmonary involvement may not only be due to the underlying vasculitis, but also to opportunistic agents, which must always be considered.