Immune responses of patients on maintenance hemodialysis after infection by SARS-CoV-2: a prospective observational cohort study.

BACKGROUND: Immune dysregulation in patients with acute COVID-19 under chronic hemodialysis (CHD) is fully not elucidated. The changes of mononuclear counts and mediators before and after HD and associations with final outcome were studied. METHOD: In this prospective study, hospitalized patients with moderate-to-severe COVID-19 under CHD and matched comparators under HD were analyzed for their absolute counts of lymphoid cells and circulating inflammatory mediators. Blood samples were collected before start and at the end of the first HD session; dialysate samples were also collected. RESULT: Fifty-nine patients with acute COVID-19 under CHD and 20 uninfected comparators under CHD were enrolled. Circulating concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10, interferon-γ and platelet-derived growth factor-A were increased in patients. Concentrations of mediators did not differ before and after HD. Significant decreases of CD4-lymphocytes and CD19-lymphocytes were found in patients. The decrease of the expression of HLA-DR on CD14-monocytes was associated with unfavorable outcome (defined as WHO-CPS 6 or more by day 28); increased counts of CD19-lymphocytes were associated with better outcomes. CONCLUSION: Patients under CHD develop an inflammatory reaction to SARS-CoV-2 characterized by increase of inflammatory mediators, decrease of circulating T-lymphocytes and decrease of the expression of HLA-DR on CD14-monocytes.

Vascular access hands-on training for young nephrologists: The fellows' experience of the N-PATH project REVAC module.

Chronic kidney disease is a major public health problem, as population studies record a prevalence of 7.2% in individuals over 30 years and is expected to increase in the future. Many of them will end up undergoing hemodialysis treatment, and vascular access is not only an essential requirement for the technique, but also a determining factor in their prognosis; for all these reasons, every nephrologist should have both theoretical and practical knowledge of vascular access; however, the practical training is generally uneven and dependent on the hospital in which you train. It is within this context that the N-PATH (Nephrology Partnership for Advancing Technology in Healthcare) program was born with the objective of training 40 young European nephrologists in theoretical and practical aspects of Interventional Nephrology. To fulfill its mission, the 2-year program is composed of four modules of 6 months each including theoretical courses and hands-on training: Renal Expert in Molecular Pathology (REMAP), Renal Expert in Vascular Access (REVAC), Renal Expert in Medical Ultrasound (REMUS), and Renal Expert in Peritoneal Dialysis (REPED). By bringing together young nephrologists from all over Europe, the goal is also to create a strong network and promote Nephrology career at the European level. This publication highlights the experience of fellows who attended the REVAC hands-on training in Milan, focused on simulation and virtual reality for vascular access, and its impact on their nephrology training.

Case Report: Kidney Transplantation in a Patient With Acquired Agammaglobulinemia and SLE. Issues and Challenges.

Lupus nephritis in the context of Systemic Lupus Erythematosus (SLE) is characterized by an unpredicted course with remissions and flare-ups. Among others, it remains a significant cause of end-stage kidney disease (ESKD) in relatively young patients. Therapeutic regimens with newer immunosuppressive agents have been introduced in order to control SLE clinical manifestations more efficiently and limit organ damage induced by immune complex formation and sustained inflammation. Treatment is usually long-term, and the cumulative impact of immunosuppression is expressed through the increased frequency of infections and neoplasms. However, if the observed immunity dysregulation is secondary and pharmaceutically induced or there is a pre-existing, primary immunodeficiency that shares common pathogenetic pathways with SLE's autoimmunity is not always clear. Herein, we present the case of a 39-year-old woman, that reached ESKD due to lupus nephritis. After an upper respiratory cytomegalovirus (CMV) infection and concomitant CMV reactivations the investigation revealed significant immunodeficiency. Not long after the initiation of intravenous immunoglobulin (IVIG) administration, patient received a cadaveric kidney transplant. IVIG was continued along with standard immunosuppression so that both recurrent infections and allograft rejection are avoided. Patient is closely monitored, and her post-transplant course is remarkably satisfying so far. ESKD patients with immunodeficiency syndromes should not be excluded by definition from kidney transplantation.