No abstract

This is the first report in an adolescent of minimal change disease (MCD) after the first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) with complete remission following steroid treatment. An 18-year-old white male with no prior medical history complained of gastrointestinal symptoms 11 days after his vaccination. Ascites and lower extremity edema were observed a few days later. He was admitted to a hospital as laboratory testing revealed proteinuria of 10.5 g/24 h, normal creatinine levels, and serum albumin of 1.8 g/dL, confirming the presence of nephrotic syndrome. Immunology and serology tests were unremarkable. A diagnostic kidney biopsy showed no significant glomerular or tubular abnormalities in light microscopy with negative immunofluorescence. Treatment with methylprednisolone 48 mg daily was initiated. A week after discharge, proteinuria declined to 1.2 g/24 h, and edema had disappeared, and 6 weeks later, complete remission was evident. As COVID-19 vaccination has been associated with the development of de novo and relapsing MCD, and this case provides additional support for this possible correlation.

Background Hypertension is the most prevalent cardiovascular risk factor in kidney-transplant-recipients (KTRs). Preliminary data suggest similar ambulatory-blood-pressure (ΒP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory-BP-profile and short-term BP-variability (BPV) in KTRs versus HD patients. Methods Two-hundred-four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP-levels, BP-trajectories and BPV indices over a 24-hour ambulatory-BP-monitoring (ABPM) in KTRs were compared against both the 1st and 2nd 24-hour period of a standard 48-hour ABPM in HD. To evaluate the effect of renal-replacement-treatment and time on ambulatory-BP-levels, two-way-ANOVA for repeated-measurements was performed. Results KTRs had significantly lower SBP and pulse-pressure (PP) levels compared to HD during all periods studied (24-hour SBP: KTR: 126.5 ± 12.1mmHg;  HD 1st 24-hour:  132.0 ± 18.1mmHg,  p = 0.006;  2nd 24-hour: 134.3 ± 17.7mmHg,  p < 0.001);  no significant differences were noted for DBP levels with the exception of 2nd nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory-SBP-levels during all periods studied, and a significant interaction between-them;  the greatest between-group difference in BP (KTRs—HD in mmHg) was observed at the end of the 2nd 24-hour (-13.9mmHg,  95%CI:  -21.5 to -6.2, p < 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-hour SBP-ARV: KTRs:  9.6 ± 2.3mmHg;  HD 1st 24-hour:  10.3 ± 3.0mmHg,  p = 0.032;  2nd 24-hour: 11.5 ± 3.0mmHg,  p < 0.001). No differences were noted in dipping pattern between the two groups. Conclusions SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more favorable ambulatory-BP-profile in KTRs, in contrast to previous observations.

Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

Background: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Methods: This study included 48 diabetic and 48 non-diabetic adult patients (> 18 years) with CKD (estimated glomerular filtration rate [eGFR] < 90 and ≥15 mL/min/1.73 m 2 ), matched in a 1: 1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-h ambulatory BP measurement with the Mobil-O-graph device. To evaluate the effect of DM and time on the trajectories of 24-h BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated with val-idated formulas. Results: In total, patients with DM had significantly higher 24-h systolic BP (SBP; 132.13 ± 10.71 vs. 124.16 ± 11.45; p = 0.001) and pulse pressure (PP; 57.1 ± 9.6 vs. 49.5 ± 10.9; p < 0.001), but similar 24-h diastolic BP (DBP; 75.00 ± 8.43 vs. 74.62 ± 6.86 mm Hg; p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP (F = 18.766, p < 0.001, partial η 2 = 0.261) and marginally significant for DBP (F = 3.782, p = 0.057, partial η 2 = 0.067). Twenty-four hour SBP SD, weighted SD (wSD) and average real variability (ARV; 10.94 ± 2.75 vs. 9.46 ± 2.10; p = 0.004), as well as 24 h DBP SD, wSD, coefficient of variation (CV) and ARV (8.23 ± 2.10 vs. 7.10 ± 1.33; p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP and PP levels are higher and SBP-profile is different in patients with diabetic compared to those with nondiabetic CKD. Systolic and diastolic BPV are also higher in diabetics. These findings may signify a higher cardiovascular risk for patients with both DM and CKD compared to patients with CKD alone, through higher BP levels and BPV.