Am J Transplant. 2020;00:1-3. | 1 amjtransplant.com | INTRODUC TI ONThe novel coronavirus outbreak has startled the world due to its widespread diffusion and socioeconomic burden. Kidney transplant recipients (KTRs) are perceived to be at high risk of infection, and immunosuppressive therapy management during this global emergency can be a challenge. Herein, we report the case of a KTR who developed SARS-CoV-2 pneumonia and recovered in 15 days while continuing administration of his usual immunosuppressive treatment. | C A S E REP ORTThe patient is a 32-year-old man who underwent kidney transplantation in September 2017 from a deceased donor; ESRD etiology was unknown. Prior to admission, February 3, 2020, his most recently measured creatinine level was 1.9 mg/dL (eGFR 46 mL/min/1.73 m 2 ).Immunosuppressive therapy consisted in tacrolimus (trough levels 6-8 ng/mL), mycophenolic acid (360 mg BID), and prednisone (5 mg).Induction therapy included ATG and basiliximab.Previous medical history was irrelevant except for hypertension and pericarditis treated with colchicine in February, 2017.On March 12, 2020, the patient was admitted to our emergency room after a fever lasting 3 days, dyspnea and non-productive cough, unsuccessfully treated with amoxicillin-clavulanate 1 g TID.Physical evaluation was normal: body temperature was 38°C and oxygen saturation was 97% in ambient air, blood pressure was 130/70 mm Hg, and respiratory rate was 25 breaths per minute.Laboratory results demonstrated a low percentage of lymphocytes (17.8%), absolute and relative monocytosis (1000/mmc; 16.7%), C-reactive protein (CRP) elevation (47.9 mg/L), and slightly elevated levels of procalcitonin (PCT) (0.33 µg/L). Renal function impairment was observed (creatinine 2.6 mg/dL, eGFR 31 mL/min/1.73 m 2 ).Pneumococcus and Legionella infections were ruled out by negative urinary antigens. Arterial blood gas analysis was suggestive of respiratory alkalosis.Chest X-ray demonstrated diffuse septal thickening in the absence of areas of consolidation.On March 13, nasopharyngeal swab testing was performed and SARS-COV-2 was identified by rRT-PCR (Day 0).

Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <–18% was shown in 55% of patients with stage 2–4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.

In recent years, following the publication of results from several RCTs, first on cardiovascular and more recently on renal outcomes, SGLT2is have become the standard of care to prevent diabetic kidney disease and slow its progression. This narrative review focuses on biological mechanisms, both renal and extrarenal, underlying kidney protection with SGLT2is. Furthermore, data from cardiovascular as well as renal outcome trials, mostly conducted in diabetic patients, are presented and discussed to provide an overview of current uses as well as the future therapeutic potential of these drugs.