Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

Background: Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear.

Because of the great problem of viral hepatitis in hemodialysis patients, the Italian Society of Nephrology decided to perform a national epidemiologic survey. We contacted 467 nephrological centers by a questionnaire which let us have information on 25,746 uremic patients: 18,338 on HD, 2,250 on PD and 5,176 with kidney transplant, respectively 78.5% of the total Italian dialysed patients and 91.4% of the total transplanted patients. Statistical analyses were performed. HBV infections occur in 7.8% of the patients (2,008 cases) but considering that 485 cases became spontaneously negative, the true overall incidence of chronic carriers falls to 4.9%. The main causes of the infection are reported as transfusions (64.3%) and dialysis environment (12%). The vaccination program performed by 93.2% of the centers, obtained an efficacious seroconversion in 4,626 of 7,790 cases vaccinated: the vaccine currently most utilized is the recombinant type administered by means of 3 versus 4 boosters. In the 2nd part of the survey, we report information concerning the presence of nephropaties associated with HBV infections in nonuremic patients (208 cases). We present and discuss the clinical picture of the nephropaties, the hystologic bioptic pattern and the prognosis of the kidney pathology.

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high morbidity and mortality but, although various treatment modalities have been tried, the optimal therapy is still debated. The present paper reports a 16-year-old patient who developed EPS 6 months after shifting to haemodialysis and, following adhesiolysis, was successfully treated with a combination of steroids, tamoxifen and everolimus, this last drug chosen for its antiproliferative effect through mammalian target of rapamycin (mTOR) inhibition and its ability to block vascular endothelial growth factor and neoangiogenesis. EPS progressively improved and the patient successfully underwent renal transplantation 5 years later. The case suggests that, in view of their mechanism of action, mTOR inhibitors should be considered as an immunosuppressive agent after renal transplantation in patients at risk and merit investigation in future trials on this condition.

The shortage of donors to face the increasing number of patients listed for renal transplantation has prompted several strategies including the use of kidneys with a tumor, whether occasionally found on harvesting from a deceased donor or intentionally removed from a living donor and transplanted after excision of the lesion. Current evidence suggests that a solitary well-differentiated RCC, Fuhrman nuclear grade I-II, less than 1 cm in diameter and resected before grafting may be considered at minimal risk of recurrence in the recipients who should however be informed of the possible risk and should consent to receive that graft.