Background The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine. Case Presentation We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient. Conclusion Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.

Vaccination is a promising strategy to control the ongoing pandemic; however, solid organ recipients tend to develop a weaker immune response to vaccination. Anti-spike SARS-CoV-2 antibodies titers were measured 2-4 weeks post-vaccination completion in 131 KT patients without previous infection. Demographic, clinical, and laboratorial parameters were analyzed to identify which factors contributed to seroconversion. Factors that influenced seroconversion, that occurred in 76 patients (58%), were longer time post-transplant, immunosuppression without an antiproliferative drug and vaccination with mRNA vaccines. Patients who received mRNA vaccines had significantly higher rates of seroconversion compared with adenovirus vector vaccines (67% vs 33%, P < .001) and higher anti-spike IgG titers.These findings reinforce the need to discuss the vaccination strategy in this population, including a third dose with a mRNA vaccine.

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Introduction: Diabetes is the leading cause of chronic kidney disease and end-stage kidney disease worldwide. A kidney biopsy in a diabetic patient must be considered when non-diabetic renal disease is suspected, such as in the presence of a rapid decline in renal function or severe unexplained proteinuria. However, the timing and criteria of a biopsy remain controversial in these patients. We aimed to identify clinical and histological markers that could help differentiate diabetic and non-diabetic renal disease and decide if this invasive approach is needed or not. Subjects and Methods: We reviewed 30 years of biopsies from diabetic patients performed at a tertiary hospital. We collected patient demographic data, biopsy indications, histological findings, and clinical and analytical data both at the moment of the biopsy and extensive followup. Based on kidney biopsy findings, patients were categorized as isolated diabetic nephropathy, non-diabetic kidney disease, or non-diabetic kidney disease superimposed on diabetic nephropathy (diabetic kidney disease). Results and Discussion: We enrolled 92 patients, mostly with type 2 diabetes, with a mean age of 62.9 ± 13.2 years. Nearly half of them had isolated diabetic nephropathy (53.3%), and 15.2% had diabetic nephropathy superimposed on non-diabetic kidney disease, comprising a total of 63 patients (68.5%) with diabetic kidney disease. Twenty-nine patients (31.5%) were considered to have non-diabetic kidney disease. These last patients were significantly less likely to need insulin therapy (p=0.002), had more frequently an acute deterioration of renal function (p=0.01), lower albumin levels (p=0.03), and a higher prevalence of microhematuria (p=0.001). We found the latter to be an independent predictor of non-diabetic kidney disease. Further, patients with the primary diagnosis of diabetic nephropathy had higher survival than those who had nondiabetic kidney disease, contradicting published data. Conclusions: The criteria for performing a biopsy in diabetic patients still lack consensus, although the priority to identify non-diabetic kidney disease prevails. We believe the non-diabetic kidney disease predictors we describe may prove helpful for determining the need for a histological assessment in diabetic patients.

BACKGROUND AND AIMS IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide and an important cause of kidney failure requiring kidney replacement therapy [1]. Given that IgAN has no specific treatment and the options available are often associated with significant side effects, searching for risk factors for disease progression can improve the prognosis determination and, therefore, support the therapeutical approach decision. Our aim was to evaluate factors that lead to poor renal survival and progression to end-stage renal disease (ESRD) in patients with histological diagnose of IgAN. METHOD A retrospective study was conducted including the patients with histological diagnose of IgAN between 2007 and 2019 that maintained regular follow-up in our center. Clinical, analytical and histological data were collected and analyzed. Renal survival was defined by a status free of ESRD and renal function decline lower than 50% over time. ESRD was defined as an estimated glomerular filtration rate (eGFR) &lt;15 mL/min/1.73 m2 or need for chronic dialysis. RESULTS A total of 59 patients were included, 39 males, with a mean age at diagnoses of 42.7 ± 17.4 years and a mean follow-up time of 8.2 ± 3.8 years. The initial mean eGFR was 84 ± 31.4 mL/min/1.73 m2 and 40.7% of patients had hypertension at time of diagnoses. A total of 41 patients (69.5%) were treated with renin–angiotensin–aldosterone system inhibitors and 16 (27.1%) with immunosuppressive agents, 13 with corticosteroids and 3 with corticosteroids and cyclophosphamide. A total of 12 patients (20.3%) showed an impaired renal survival during the follow-up, and 7 (11.9%) progressed to ESRD. We found that time-average proteinuria was significantly higher in patients who presented poor renal survival (1.26 ± 0.89 g/24 h versus 3.21 ± 2.2 g/24 h; P &lt; .001). Also, the proportion of patients reaching ESRD or a 50% reduction of renal function was significantly greater among patients with persistent hematuria during the follow-up than in those who presented resolution of hematuria (28.2% versus 17.9% and 53.8% versus 0%; P = .002). Furthermore, we found that patients who presented on the kidney biopsy a more intense immunofluorescence staining of C3 were more likely to evolve to ESRD or have greater loss of kidney function (p=.001). Other variables, such as male gender, lower eGFR and presence of hypertension at diagnoses, also showed to be related to poor renal survival, although they did not reach statistical significance. The treatment with renin–angiotensin–aldosterone system inhibitors or immunosuppressive agents did not show impact on renal survival. CONCLUSION The grade of proteinuria is a well-established predictor of worse outcomes in patients with IgAN, and its reduction is one of the main objectives in these patients. On the other hand, the role of hematuria in disease progression is still controversial and the relationship between the level of C3 deposition and the long-term prognosis has rarely been reported [1, 2, 3]. With our data, we reinforce the need to integrate all different pathophysiological mechanisms to establish the disease prognosis.