BACKGROUND AND AIMS SGLT2 inhibitors (SGLT2i) are the first-line therapy in patients with type 2 diabetes mellitus (DM2) and CKD, together with metformin according to most recent published guidelines. They are related to better renal and cardiovascular outcomes. SGLT2i could be potentially benefitial in terms of renal function preservation and cardiovascular outcomes in kidney transplantion (KT). Despite published data about SGLT2i in KT patients with DM2 or new-onset diabetes after transplantation are limited, their use seems to be common in everyday clinical practice. Our aim is to investigate if SGLT2i are safe and well tolerated in a cohort of KT recipients, as well as to analyze clinical and laboratory data at 6 months after SGLT2i initiation. METHOD Multicentre observational study in KT recipients with diabetes under SGLT2i treatment. RESULTS A total of 323 patients were included, and 284 completed a 6-month follow-up. Mean age was 61.2 ± 10.3 years old, 74.4% were men and 41% presented DM2. Previous antidiabetic therapies: insulin (48.1%), DPP4 inhibitors (36.1%) and metformin (33.1%). Empagliflozine was started in 55.8%, dapagliflozine in 23.2% and canagliflozin in 20.6%. After SGLT2i initiation, body weight reduction, an improvement in blood pressure and glycaemic control, higher haemoglobin levels and a decrease in cholesterol levels were observed. Also, a mild decrease in eGFR was detected while albuminuria was lower. These differences were statistically significant (Table 1). In 34 patients (10.5%), SGLT2i was stopped: 2.78% presented urinary tract infection (UTI), 1.5% balanitis and 1.2% important eGFR decreasing slope. During the study period, six patients presented a graft loss (one related to SLGT2) and six patients died (deaths not related to SGLT2i). CONCLUSION SGLT2i have a safe security profile in KT, and are related to a better glycaemic and blood pressure control, as well as to a decrease in albuminuria, and to an improvement in cardiovascular risk factors. Thus, SGLT2i should be prescribed in KT recipients with DM2 or NODAT with adequate eGFR. UTI surveillance is essential in these patients.

Background and Aims Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Method All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusion 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

Background COVID-19 infection manifests as pneumonia associated with multiple organ failure, and death. Acute kidney injury is a risk factor for mortality. There is limited scientific literature on COVID-19 infection and allergic tubulointerstitial nephritis, its clinical course and short- and long-term prognosis. Method We performed a retrospective study where medical records of 60 patients with histological diagnosis of allergic tubulointerstitial nephritis from January 2009 to November 2020. In these patients, we studied the incidence of COVID-19 infection, clinical characteristics and prognosis from March to the actual date. Results Of 60 patients with allergic tubulointerstitial nephritis, 6 (10%) patients were diagnosed with COVID-19. The first case, an 85-year-old woman with a history of metastatic melanoma treated with nivolumab and allergic tubulointerstitial nephritis by immunobiological agents in 2018, diagnosed with mild COVID-19 infection in April 2020 without deterioration of renal function in controls at 3 and 6 months of follow-up. The second case, a 51-year-old woman with a history of large B-cell lymphoma with plasmacytic differentiation and progression to multiple myeloma of lambda light chains and allergic tubulointerstitial nephritis due to chemotherapy since 2019, admitted for acute pyelonephritis and PRES syndrome secondary to first dose of bortezomib complicated with COVID-19 nosocomial pneumonia and acute pancreatitis treated with corticosteroids and broad spectrum antibiotic therapy; she died of abdominal refractory septic shock. The third patient, a 64-year-old man without prior renal impairment, was admitted for severe COVID-19 pneumonia and acute kidney injury secondary to acute tubulointerstitial nephritis of uncertain etiology that required orotracheal intubation and continuous veno-venous hemodiafiltration for a week who received methylprednisolone in bolus for 3 days and continued treatment with corticosteroid therapy with complete recovery of renal function and improvement in proteinuria at 3 months of follow-up. The fourth patient, an 82-year-old woman with acute kidney injury AKIN 3 secondary to acute allergic tubulointerstitial nephritis related to ciprofloxacin complicated with severe COVID-19 nosocomial pneumonia, who died despite ventilatory support and high-dose steroids therapy and tocilizumab. The fifth patient, a 75-year-old with a history of metastatic lung adenocarcinoma treated with immunobiological agents and allergic tubulointerstitial nephritis in  2018, admitted in march 2020 for mild COVID-19 pneumonia treated with steroids and hydroxychloroquine without deterioration of respiratory and kidney function.  The sixth patient, an 86-years-old man with acute kidney injury AKIN 3 due to acute allergic tubulointerstitial nephritis secondary to proton-binding inhibitors and nosocomial COVID-19 infección with improvement of kidney function with steroids therapy only.  Conclusion Our 6 patients with allergic tubulointerstitial nephritis and COVID-19 infection presented different spectrum of the disease. It seems that nosocomial COVID-19 infection in patients admitted with recent diagnosis of acute allergic tubulointerstitial nephritis presented a worse clinical prognosis compared with long-term diagnosed acute tubulointerstitial nephritis. Further studies with a larger sample size are needed.

No abstract

No abstract