Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas.

PURPOSE: To identify presurgical and surgical risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs). METHODS: Retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. Intraoperative hypertensive crisis was defined as systolic blood pressure (SBP) greater than 200 mmHg lasting more than 1 min and postoperative hypertensive crisis as SBP greater than 180 mmHg or diastolic blood pressure (DBP) greater than 110 mmHg. RESULTS: A total of 296 surgeries were included. Alpha presurgical blockade was employed in 93.2% of the cases and beta-adrenergic in 53.4%. Hypertensive crisis occurred in 20.3% ( n  = 60) of the surgeries: intraoperative crisis in 56 and postoperative crisis in 6 cases (2 cases had both types of crises). We identified as risk factors of intraoperative hypertensive crisis, absence of presurgical glucocorticoid therapy (odds ratio [OR] 3.48; 95% confidence interval [CI] 1.19-10.12) higher presurgical SBP (OR 1.22 per each 10 mmHg, 95% CI 1.03-1.45), a larger tumor size (OR 1.09 per each 10 mm, 95% CI 1.00-1.19) and absence of oral sodium repletion (OR 2.59, 95% CI 1.25-5.35). Patients with hypertensive crisis had a higher rate of intraoperative bleeding ( P  < 0.001), of intraoperative hemodynamic instability ( P  < 0.001) and of intraoperative hypotensive episodes ( P  < 0.001) than those without hypertensive crisis. CONCLUSION: Intraoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients not pretreated with glucocorticoid therapy before surgery, with larger tumors and higher presurgical SBP and who do not receive oral sodium repletion have a higher risk for developing hypertensive crisis during and after PPGL surgery.

The Communication of Bad News in Palliative Care: The View of Professionals in Spain.

BACKGROUND: Communication is one of the central axes around which end-of-life care revolves in the context of palliative care. Communication of bad news is reported as one of the most difficult and stressful tasks by palliative care professionals. Therefore, the aim of this study is to identify aspects related to the communication of bad news in palliative care in Spain. METHODS: Descriptive cross-sectional study. An ad hoc questionnaire was designed and sent by e-mail to all palliative care teams in Spain. RESULTS: Overall, 206 professionals (102 nurses, 88 physicians and 16 psychologists) completed the questionnaire. A total of 60.2% considered their communication of bad news skills to be good or very good. This was related to older age, experience in both the profession and palliative care, and to having received specific postgraduate training (P < .001). Around 42.2% perform communication of bad news with the patient first, which is associated with lower skill (P = .013). About 78.15% of the professionals do not use any specific protocol. CONCLUSION: This study suggests that patients access palliative care with little information about their diagnosis and prognosis. The barriers identified in the communication of bad news are the lack of specific education and training in protocol management, the difficult balance between hope and honesty, the young age of the patient, and the family.

Local recurrence and metastatic disease in pheochromocytomas and sympathetic paragangliomas.

Purpose: To evaluate the rate of recurrence among patients with pheochromocytomas and sympathetic paragangliomas (PGLs; together PPGLs) and to identify predictors of recurrence (local recurrence and/or metastatic disease). Methods: This retrospective multicenter study included information of 303 patients with PPGLs in follow-up in 19 Spanish tertiary hospitals. Recurrent disease was defined by the development of local recurrence and/or metastatic disease after initial complete surgical resection. Results: A total of 303 patients with PPGLs that underwent 311 resections were included (288 pheochromocytomas and 15 sympathetic PGLs). After a median follow-up of 4.8 years (range 1-19), 24 patients (7.9%) had recurrent disease (3 local recurrence, 17 metastatic disease and 4 local recurrence followed by metastatic disease). The median time from the diagnosis of the PPGL to the recurrence was of 11.2 months (range 0.5-174) and recurrent disease cases distributed uniformly during the follow-up period. The presence of a pathogenic variant in SDHB gene (hazard ratio [HR] 13.3, 95% CI 4.20-41.92), higher urinary normetanephrine levels (HR 1.02 per each increase in standard deviation, 95% CI 1.01-1.03) and a larger tumor size (HR 1.01 per each increase in mm, 95% CI 1.00-1.02) were independently associated with disease recurrence. Conclusion: The recurrence of PPGLs occurred more frequently in patients with SDHB mutations, with larger tumors and with higher urinary normetanephrine levels. Since PPGL recurrence may occur at any time after the initial PPGL diagnosis is performed, we recommend performing a strict follow-up in all patients with PPGLs, especially in those patients with a higher risk of recurrent disease.

Long-lasting biofouling formation on transparent fouling-release coatings for the construction of efficient closed photobioreactors.

In order to build an efficient closed-photobioreactor (PBR) in which biofouling formation is avoided, a non-toxic coating with high transparency is required, which can be applied to the interior surface of the PBR walls. Nowadays, amphiphilic copolymers are being used to inhibit microorganism adhesion, so poly(dimethylsiloxane)-based coatings mixed with poly(ethylene glycol)-based copolymers could be a good option. The 7 poly(dimethylsiloxane)-based coatings tested in this work contained 4% w/w of poly(ethylene glycol)-based copolymers. All were a good alternative to glass because they presented lower cell adhesion. However, the DBE-311 copolymer proved the best option due to its very low cell adhesion and high transmittance. Furthermore, XDLVO theory indicates that these coatings should have no cell adhesion at time 0 since they create a very high-energy barrier that microalgae cells cannot overcome. Nevertheless, this theory also shows that their surface properties change over time, making cell adhesion possible on all coatings after 8 months of immersion. The theory is useful in explaining the interaction forces between the surface and microalgae cells at any moment in time, but it should be complemented with models to predict the conditioning film formation and the contribution of the PBR's fluid dynamics over time.

Continued Organic Fertigation after Basal Manure Application Does Not Impact Soil Fungal Communities, Tomato Yield or Soil Fertility.

There is currently a limited understanding of the complex response of fungal microbiota diversity to organic fertigation. In this work, a 2-year field trial with organic tomato crops in a soil previously amended with fresh sheep manure was conducted. Two hypotheses were compared: (i) fertigation with organic liquid fertilizers versus (ii) irrigation with water. At the end of both years, soils were analyzed for physical-chemical parameters and mycobiome variables. Plate culture and DNA metabarcoding methods were performed in order to obtain a detailed understanding of soil fungal communities. Fertigation did not increase any of the physical-chemical parameters. Concerning soil fungal communities, differences were only found regarding the identification of biomarkers. The class Leotiomycetes and the family Myxotrichaceae were identified as biomarkers in the soil fungal community analyzed by means of DNA metabarcoding of the "fertigation" treatment at the end of Year 1. The Mortierella genus was detected as a biomarker in the "water" treatment, and Mucor was identified in the "fertigation" treatment in the cultivable soil fungi at the end of Year 2. In both years, tomato yield and fruit quality did not consistently differ between treatments, despite the high cost of the fertilizers added through fertigation.

Bioactives Overproduction through Operational Strategies in the Ichthyotoxic Microalga Heterosigma akashiwo Culture.

The red tide-forming microalga Heterosigma akashiwo has been associated with massive events of fish deaths, both wild and cultured. Culture conditions are responsible for the synthesis or accumulation of some metabolites with different interesting bioactivities. H. akashiwo LC269919 strain was grown in a 10 L bubble column photobioreactor artificially illuminated with multi-coloured LED lights. Growth and production of exopolysaccharides, polyunsaturated fatty acids (PUFAs), and carotenoids were evaluated under different culture modes (batch, fed-batch, semicontinuous, and continuous) at two irradiance levels (300 and 700 µE·s-1·m-2). Continuous mode at the dilution rate of 0.2·day-1 and 700 µE·s-1·m-2 provided the highest production of biomass, PUFAs (132.6 and 2.3 mg·L-1·day-1), and maximum fucoxanthin productivity (0.16 mg·L-1·day-1). The fed-batch mode accumulated exopolysaccharides in a concentration (1.02 g·L-1) 10-fold over the batch mode. An extraction process based on a sequential gradient partition with water and four water-immiscible organic solvents allowed the isolation of bioactive fucoxanthin from methanolic extracts of H. akashiwo. Metabolites present in H. akashiwo, fucoxanthin and polar lipids (i.e., eicosapentaenoic acid (EPA)), or probably such as phytosterol (ß-Sitosterol) from other microalgae, were responsible for the antitumor activity obtained.

Allostatic-interoceptive anticipation of social rejection.

Anticipating social stress evokes strong reactions in the organism, including interoceptive modulations. However, evidence for this claim comes from behavioral studies, often with inconsistent results, and relates almost solely to the reactive and recovery phase of social stress exposure. Here, we adopted an allostatic-interoceptive predictive coding framework to study interoceptive and exteroceptive anticipatory brain responses using a social rejection task. We analyzed the heart-evoked potential (HEP) and task-related oscillatory activity of 58 adolescents via scalp EEG, and 385 human intracranial recordings of three patients with intractable epilepsy. We found that anticipatory interoceptive signals increased in the face of unexpected social outcomes, reflected in larger negative HEP modulations. Such signals emerged from key brain allostatic-interoceptive network hubs, as shown by intracranial recordings. Exteroceptive signals were characterized by early activity between 1-15 Hz across conditions, and modulated by the probabilistic anticipation of reward-related outcomes, observed over distributed brain regions. Our findings suggest that the anticipation of a social outcome is characterized by allostatic-interoceptive modulations that prepare the organism for possible rejection. These results inform our understanding of interoceptive processing and constrain neurobiological models of social stress.

Genetic Study in Pheochromocytoma: Is It Possible to Stratify the Risk of Hereditary Pheochromocytoma?

INTRODUCTION: It is estimated that 30-40% of patients with apparently sporadic pheochromocytomas (PHEOs) have an inherited predisposition syndrome. The aim of our study was to develop a predictive model of hereditary PHEO based on the clinical, hormonal, and radiological features present at the diagnosis of patients with PHEOs. METHODS: A retrospective multicenter cohort study of patients with PHEOs with available genetic study from 18 tertiary hospitals. Clinical, biochemical, and radiological features were used to build a multivariate logistic regression model. The estimation of all possible equations was used to select the model with the best diagnostic accuracy (lower Akaike index). RESULTS: A total of 245 patients were included: 169 (69.0%) patients with sporadic PHEOs and 76 (31%) with hereditary PHEOs. The parsimonious predictive model with the highest diagnostic accuracy for the prediction of hereditary PHEO combined the variables age, non-cardiovascular disease, urinary norepinephrine levels, and tumor size. The area under the ROC curve of this model was 0.800 (0.705-0.887). Based on the predictive model, the probability of hereditary PHEO in patients older than 60 years with cardiovascular disease, high levels of urinary norepinephrine and unilateral PHEOs >60 mm was <2%. And if the age was above 80 years, lower than 1%. The probability of sporadic PHEO linearly increased with age (MH Test for linear Trend: χ2 (1) = 30.05; p < 0.001). CONCLUSION: In certain populations such as old patients with cardiovascular disease, with high levels of urinary norepinephrine and large tumors in which the probability of hereditary PHEO is very low, genetic testing could be avoided in the absence of specific suspicion.

Magnetite-based nanoparticles and nanocomposites for recovery of overloaded anaerobic digesters.

The effect of magnetite nanoparticles and nanocomposites (magnetite nanoparticles impregnated into graphene oxide) supplement on the recovery of overloaded laboratory batch anaerobic reactors was assessed using two types of starting inoculum: anaerobic granular sludge (GS) and flocculent sludge (FS). Both nanomaterials recovered methane production at a dose of 0.27 g/L within 40 days in GS. Four doses of magnetite nanoparticles from 0.075 to 1 g/L recovered the process in FS systems between 30 and 50 days relaying on the dose. The presence of nanomaterials helped to reverse the effect of volatile fatty acids inhibition and enabled microbial communities to recover but also favoured the development of certain microorganisms over others. In GS reactors, the methanogenic population changed from being mostly acetoclastic (Methanothrix soehngenii) to being dominated by hydrogenotrophic species (Methanobacterium beijingense). Nanomaterial amendment may serve as a preventative measure or provide an effective remedial solution for system recovery following overloading.

Impacto de la pandemia por COVID-19 en la implantación de una guía de buenas prácticas sobre las lesiones por presión / Impact of the COVID-19 pandemic on the implementation of best practice guidelines on pressure injuries

Objetivo: Evaluar el impacto de la COVID-19 en la implantaciónde la Guía de Buenas Prácticas clínicas de la Registered Nurses’Association of Ontario, de valoración del riesgo y prevención de laslesiones por presión sobre los indicadores de calidad asistencial enla Unidad de Medicina Interna del Hospital Universitari GermansTrias i Pujol. Metodología: Estudio observacional, analítico, de 2cohortes retrospectivas, que compara los indicadores de calidad pre ypostimplementación de 2017 con los del año 2021. Explotación dedatos de forma retrospectiva y pseudoanonimizada. Análisis descriptivounivariante, así como inferencial para el contraste de hipótesis deestudio. En todos los casos se utilizaron aproximaciones bilaterales,siendo el nivel de significación del 5% (α = 0,05). Resultados: Seincluyeron 946 sujetos, de los que el 49,9% fueron hombres y el50,1% mujeres. La media de edad fue de 75 años. La incidencia delesiones por presión fue del 8,1% en 2017 y del 8,9% en 2021, sinexistir evidencias estadísticamente significativas (p = 0,8). Respectoa la proporción de lesiones por presión de origen nosocomial,también se observó un considerable aumento, que fue del 27,5% en2017 y del 60% en 2021, aunque tampoco se hallaron diferenciasestadísticamente significativas (p = 0,094). Sin embargo, en cuantoal riesgo de presentar lesiones por presión y de su aparición, sí que seobservaron diferencias estadísticamente significativas en ambos años (p< 0,001 en 2017, y p = 0,011 en 2021). Conclusiones: La pandemiaobligó a detener el proceso de implantación de las guías de buenasprácticas, repercutiendo en los indicadores de calidad asistencial. (AU)

Objective: To assess the impact of COVID-19 on theimplementation of the Risk Assessment and Prevention ofPressure Ulcers Best Practice Guideline (BPG) of the RegisteredNurses’ Association of Ontario, in quality indicators in thegeneral internal medicine unit of the Hospital UniversitariGermans Trias i Pujol. Methodology: Observational studyof 2 retrospective cohorts, comparing the pre- and postimplementation quality indicators of 2017 with those ofthe year 2021. A pseudonymized data exploitation wasconducted for subsequent univariate descriptive analysis, aswell as inferential analysis and hypothesis contrasting. Bilateralapproaches were used in all cases, with a significance level of 5%(α = 0.05). Results: A total of 946 individuals were included, ofwhich 49.9% were men and 50.1% were women. The mean agewas 75 years. The incidence of PI was 8.1% in 2017 and 8.9%in 2021, with no statistically significant difference (p = 0.8).Regarding the proportion of hospital-acquired PI, a considerableincrease was also observed, being 27.5% in 2017 and 60% in2021, although no statistically significant differences were foundeither (p = 0.094). However, regarding the risk of presentingPI and their incidence, statistically significant differences wereobserved in both years (p < 0.001 in 2017, and p = 0.011 in2021). Conclusions: The pandemic made it necessary to stopthe BPG implementation process, impacting negatively on thequality of care indicators. (AU)

Evaluation of In Vitro Protein Hydrolysis in Seven Insects Approved by the EU for Use as a Protein Alternative in Aquaculture.

Rapid population growth is leading to an increase in the demand for high-quality protein such as fish, which has led to a large increase in aquaculture. However, fish feed is dependent on fishmeal. It is necessary to explore more sustainable protein alternatives that can meet the needs of fish. Insects, due to their high protein content and good amino acid profiles, could be a successful alternative to fishmeal and soybean meal traditionally used in sectors such as aquaculture. In this work, seven species of insects (Hermetia illucens, Tenebrio molitor, Acheta domestica, Alphitobius diaperinus, Gryllodes sigillatus, Gryllus assimilis, and Musca domestica) approved by the European Union (UE) for use as feed for farmed animals (aquaculture, poultry, and pigs) were studied. Their proximate composition, hydrolysis of organic matter (OMd), hydrolysis of crude protein (CPd), degree of hydrolysis (DH/NH2 and DH/100 g DM), and total hydrolysis (TH) were analyzed. The results showed that Tenebrio molitor had digestibility similar to that of fishmeal, while Acheta domestica and Hermetia illucens provided similar digestibility to that of soybean meal. The acid detergent fiber (ADF) data were negatively correlated with all protein digestibility variables. The differences in the degree of hydrolysis (DH) results and the similarity in total hydrolysis (TH) results could indicate the slowing effects of ADF on protein digestibility. Further in vivo studies are needed.

Adsorption Analysis of Exopolymeric Substances as a Tool for the Materials Selection of Photobioreactors Manufacture.

An improved method that allows the robust characterization of surfaces is necessary to accurately predict the biofouling formation on construction materials of photobioreactors (PBR). Exopolymeric substances (EPS), such as proteins and polysaccharides, have been demonstrated to present a similar behavior to cells in terms of surface adhesion. In this work, these EPS were used to optimize parameters, such as EPS concentration or adsorption time, to evaluate accurately the adsorption capacity of surfaces and, with it, predict the biofouling formation in contact with microalgae cultures. Once the method was optimized, the characterization of seven commercial polymeric surfaces was submitted to different abrasive particles sizes, which modified the roughness of the samples, as well as protein and polysaccharide lawns, which were prepared and carried out in order to evaluate the characteristics of these substances. The characterization consisted of the determination of surface free energy, water adhesion tension, and critical tension determined from the measurement of the contact angle, roughness, surface zeta potential, and the EPS adhesion capacity of each material. This will be useful to understand the behavior of the surface in the function of its characteristics and the interaction with the solutions of EPS, concluding that the hydrophobic and smooth surfaces present good anti-biofouling characteristics.

The Isolation of Specialty Compounds from Amphidinium carterae Biomass by Two-Step Solid-Phase and Liquid-Liquid Extraction.

The two main methods for partitioning crude methanolic extract from Amphidinium carterae biomass were compared. The objective was to obtain three enriched fractions containing amphidinols (APDs), carotenoids, and fatty acids. Since the most valuable bioproducts are APDs, their recovery was the principal goal. The first method consisted of a solid-phase extraction (SPE) in reverse phase that, for the first time, was optimized to fractionate organic methanolic extracts from Amphidinium carterae biomass using reverse-phase C18 as the adsorbent. The second method consisted of a two-step liquid-liquid extraction coupled with SPE and, alternatively, with solvent partitioning. The SPE method allowed the recovery of the biologically-active fraction (containing the APDs) by eluting with methanol (MeOH): water (H2O) (80:20 v/v). Alternatively, an APD purification strategy using solvent partitioning proved to be a better approach for providing APDs in a clear-cut way. When using n-butanol, APDs were obtained at a 70% concentration (w/w), whereas for the SPE method, the most concentrated fraction was only 18% (w/w). For the other fractions (carotenoids and fatty acids), a two-step liquid-liquid extraction (LLE) method coupled with the solvent partitioning method presented the best results.

Effect of Nitrogen, Phosphorous, and Light Colimitation on Amphidinol Production and Growth in the Marine Dinoflagellate Microalga Amphidinium carterae.

The marine dinoflagellate microalga Amphidinium carterae is a source of amphidinols, a fascinating group of polyketide metabolites potentially useful in drug design. However, Amphidinium carterae grows slowly and produces these toxins in tiny amounts, representing a hurdle for large-scale production. Understanding dinoflagellate growth kinetics under different photobioreactor conditions is imperative for promoting the successful implementation of a full-scale integrated bioproduct production system. This study evaluates the feasibility of growing Amphidinium carterae under different ranges of nitrogen concentration (NO3- = 882-2646 µM), phosphorus concentration (PO33- = 181-529 µM), and light intensity (Y0 = 286-573 µE m-2 s-1) to produce amphidinols. A mathematical colimitation kinetic model based on the "cell quota" concept is developed to predict both algal growth and nutrient drawdown, assuming that all three variables (nitrogen, phosphorous and light) can simultaneously colimit microalgal growth. The model was applied to the semicontinuous culture of the marine microalgae Amphidinium carterae in an indoor LED-lit raceway photobioreactor. The results show that both growth and amphidinol production strongly depend on nutrient concentrations and light intensity. Nonetheless, it was possible to increase Amphidinium carterae growth while simultaneously promoting the overproduction of amphidinols. The proposed model adequately describes Amphidinium carterae growth, nitrate and phosphate concentrations, and intracellular nitrogen and phosphorus storage, and has therefore the potential to be extended to other systems used in dinoflagellate cultivation and the production of bioproducts obtained therein.

Determination of Quality Parameters in Mangetout (Pisum sativum L. ssp. arvense) by Using Vis/Near-Infrared Reflectance Spectroscopy.

Pisum sativum L. ssp. arvense, is colloquially called tirabeque or mangetout because it is eaten whole; its pods are recognized as a delicatessen in cooking due to its crunch on the palate and high sweetness. Furthermore, this legume is an important source of protein and antioxidant compounds. Quality control in this species requires the analysis of a large number of samples using costly and laborious conventional methods. For this reason, a non-chemical and rapid technique as near-infrared reflectance spectroscopy (NIRS) was explored to determine its physicochemical quality (color, firmness, total soluble solids, pH, total polyphenols, ascorbic acid and protein content). Pod samples from different cultivars and grown under different fertigation treatments were added to the NIRS analysis to increase spectral and chemical variability in the calibration set. Modified partial least squares regression was used for obtaining the calibration models of these parameters. The coefficients of determination in the external validation ranged from 0.50 to 0.88. The RPD (standard deviation to standard error of prediction ratio) and RER (standard deviation to range) were variable for quality parameters and showed values that were characteristic of equations suitable for quantitative prediction and screening purposes, except for the total soluble solid calibration model.

Influence of abiotic conditions on the biofouling formation of flagellated microalgae culture.

This work analyses the adhesion of flagellated microalgae to seven surfaces that have different water adhesion tension characteristics. Chlamydomonas reinhardtii and Isochrysis galbana, were cultivated in batch and fed-batch mode at four nitrogen/phosphorus (N/P) ratios (from 1.29 to 70) and subjected to four irradiance levels (50, 100, 200 and 400 µE·s-1·m-2) at 23 °C. Cell adhesion was greater in C. reinhardtii and a higher biomass concentration was obtained for this strain, reaching 2 g·L-1 compared to 1 g·L-1 for I. galbana. The adhesion of cells and exopolymeric substances was measured upon the batch and the first fed-batch reaching the stationary growth phase, observing a direct correlation between them and inversely to biomass generation in the cultures. The protein adhesion data for the different materials are comparable to those for cell adhesion coinciding with minimums of Baier's theory and Vogler. It is observed displacements in the curves as a function of the irradiance level.

Pre-Treatment of Fish By-Products to Optimize Feeding of Tenebrio molitor L. Larvae.

Fish discards are organic waste with high and good-quality protein levels, as well as a fatty acid profile rich in n-3 LCPUFAs, mainly eicosapentaenoic acid and docosahexaenoic acid. These discards can be used as food for Tenebrio molitor (Linnaeus, 1758) larvae, thus increasing the nutritional value of this insect. This study focused on increasing larval acceptance of fish through different pre-treatments of the diets provided, as well as increasing the accumulation of EPA and DHA in fish-fed larvae. Four different diets were prepared: control (broiler feed), DGF50: 50% dried ground fish (Pagellus bogaraveo, Brünnich, 1768) + 50% broiler feed, for different periods, FGF100: 100% fresh ground P. bogaraveo and DUF100: 100% dried whole unground P. bogaraveo. Growth, mortality, proximate composition, fatty acid profile and lipid nutritional indices were determined. Larvae fed with FGF100 displayed better results among treatments, doubling the initial weight, as well as increasing their protein level and decreasing fat levels. Regarding fatty acids, eicosapentaenoic acid and docosahexaenoic acid were only detected in larvae fed with a fish-based diet for a period longer than 5 days. These results show that pre-treatment of fish-based diets causes changes in the growth and compositional parameters of T. molitor larvae.

SARS-CoV-2 infection associated with monoclonal gammopathy. A case report based on the study of minimally invasive ultrasound-guided autopsy.

Coronavirus disease-2019 (COVID-19) is a global public health emergency with numerous clinical facets, including acute kidney injury and acute cerebrovascular disease. Further knowledge of its various pathogenic mechanisms is essential, including coagulation disorders. Monoclonal gammopathy is characterized by the overproduction of a monoclonal immunoglobulin caused by clonal proliferation. Using a postmortem study of ultrasound-guided percutaneous core biopsies, the aim of this report is to present our observations on the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection pathology associated with monoclonal gammopathy. The clinical presentation was acute renal failure. Pathological findings revealed kappa light chain cast nephropathy. SARS-CoV-2 immunohistochemistry was positive in some renal tubular cells. Another notable finding was the presence of a high density of alveolar megakaryocytes, which probably explained the final outcome (acute cerebrovascular disease). Immunohistochemical study for SARS-CoV-2 does not verify the pathogenic effect of the virus and thus its contribution to the acute kidney injury.