De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID-19 infection.

The negative impact of COVID-19 on adults with underlying chronic kidney disease, including kidney transplant recipients, has been well documented. Children have a less severe presentation and better prognosis compared to adults. However, little is known regarding the spectrum of COVID-19 infection in children and adolescents with underlying autoimmune disorders necessitating solid organ transplant and long-term immunosuppressive therapy. Case Report. An adolescent male developed end-stage kidney disease secondary to microscopic polyangiitis requiring a living-donor kidney transplant. Six years later, he developed antibody-mediated rejection of his kidney transplant. During his rejection treatment course, he contracted SARS-CoV-2 and developed new-onset nephrotic syndrome with severe acute kidney injury. Kidney transplant biopsy revealed de novo collapsing focal segmental glomerulosclerosis on a background of chronic active antibody mediated rejection. Immunostaining for SARS-CoV-2 on the biopsy specimen demonstrated positive staining of the proximal tubular epithelium consistent with intra-renal viral infection. Pulse corticosteroids, intravenous immunoglobulin, and temporary reduction of anti-metabolite therapy resulted in successful recovery with return of graft function back to pre-infection baseline. This case highlights the clinical conundrum of treating kidney transplant recipients with active rejection in the midst of the COVID-19 pandemic. Pediatric kidney transplant recipients can develop severe COVID-19-related kidney complications. Judicious immunosuppression modulation is necessary to balance infection and rejection risk.

Direct comparison of nanoindentation and macroscopic measurements of bone viscoelasticity.

Nanoindentation has become a standard method for measuring mechanical properties of bone, especially within microstructural units such as individual osteons or trabeculae. The use of nanoindentation to measure elastic properties has been thoroughly studied and validated. However, it is also possible to assess time dependent properties of bone by nanoindentation. The goal of this study was to compare time dependent mechanical properties of bone measured at the macroscopic level with those measured by nanoindentation. Twelve samples were prepared from the posterior distal femoral cortex of young cows. Initially, dogbone samples were prepared and subjected to torsional stress relaxation in a saline bath at 37 °C. A 5 mm thick disk was subsequently sectioned from the gage length, and subjected to nanoindentation. Nanoindentation was performed on hydrated samples using a standard protocol with 20 indents performed in 20 different osteons in each sample. Creep and stress relaxation data were fit to a Burgers four parameter rheological model, a five parameter generalized Maxwell model, and a three parameter standard linear solid. For Burgers viscoelastic model, the time constants measured by nanoindentation and torsion were weakly negatively correlated, while for the other two models the time constants were uncorrelated. The results support the notion that the viscoelastic behavior of bone at the macroscopic scale is primarily due to microstructural features, interfaces, or fluid flow, rather than viscous behavior of the bone tissue. As viscoelasticity affects the fatigue behavior of materials, the microscale properties may provide a measure of bone quality associated with initial damage formation.