In this cohort of male Caucasian heroin addicts, HCV-associated MPGN was the most frequent pattern of nephropathy, showing that the nephropathy associated with heroin abuse in Caucasians is not of the focal and segmental glomerulosclerosis type, in contrast to previous reports on African-Americans. This aspect may have important implications for patient management and prognosis.

End-stage renal disease (ESRD) patients present high incidence of cardiovascular (CV) events, which are the most common causes of death in these patients. The occurrence of CV events appears as a consequence of the high prevalence of traditional and nontraditional CV risk factors. Online-hemodiafiltration (OL-HDF) was introduced as a better alternative to conventional dialysis, as it was proposed to be more biocompatible, to increase dialysis efficacy, to reduce the inflammatory response to treatment and to improve patient's quality of life, contributing to reduce CV and all-cause mortality risk in ESRD. However, data in literature, comparing the effect of OL-HDF with conventional dialysis for clinical CV outcome and all-cause mortality, yielded controversy about those benefits of OL-HFD over standard hemodialysis. A review of the traditional CV risk factors (e.g., arterial hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and advanced age), non-traditional risk factors (e.g., anemia, oxidative stress, hyperphosphatemia, endothelial dysfunction, left ventricular hypertrophy, insulin resistance, high levels of lipoprotein(a) and inflammation) and potential renocardiovascular biomarkers, in the setting of ESRD, is presented. The impact of conventional hemodialysis and OL-HDF on CV risk factors and on the outcome of ESRD patients is also addressed.

The family history is a traditional section of the clinical record. Data on family members in the clinical record may be anonymous but yet these may be easily identifiable; therefore, exposing the relatives of the patient to the fact that a written record is produced, mentioning them, without their consent. This is in direct contradiction with European data protection and other regulations and in contradiction with a reasonable ethical perspective. For the purpose of obtaining an image of the present state of affairs, we used as a convenience sample, the series of Case Records published in 2019 in The New England Journal of Medicine (January to December). From a total number of 40 reports, identifiable relatives were present in 30. The number of identifiable relatives varied between none and 6. It is not the right of each individual to disclose sensitive clinical information regarding other persons, without consent from these latter. Family history should no longer include identifiable relatives, unless consent is obtained from each identifiable person. The authors offer the following guidelines on this topic: (1) Do not mention any identifiable relative of the patient in the medical history without consent from the said relative; (2) Do not mention in the family history clinical conditions seemingly unrelated to the present clinical situation; (3) Do not mention in the family history clinical conditions that the patient does not (him/) herself have and that may be seen as social stigmata; (4) Consult the institutional Ethics committee in case of reasonable doubt.

Background and Aims In the pediatric population, transplantation remains the first-line therapy in patients with end-stage renal disease (ESRD). However, it is not always possible, increasing the need for other kidney replacement therapy (KRT) modalities, and hemodialysis (HD) has been growing as a modality choice in recent years. To provide quality HD treatment, efficient vascular access is mandatory, and the arteriovenous fistula (AVF) is advocated as the best long-term access option. However, its creation is technically challenging, and its development and maintenance are some of the most difficult elements in the pediatric population. In this study, we describe our experience in the utilization of AVFs in children and adolescents on HD. Method We conducted a retrospective study including all the AVFs performed in our center on underage patients between January 2006 and December 2022. We reviewed the medical records, collected data on demographic variables, AVF characteristics, blood test results, and clinical outcomes. Statistical analysis was performed using SPSS software. Results Forty-three AVFs were performed in 32 pediatric patients. The median age at first AVF construction was 13.5 years (min 4.8; max 17.9). The most frequent etiology of ESRD was congenital anomalies of kidney and urinary tract (n = 20, 62.5%) and most patients (n = 24, 75.0%) were already receiving KRT. Median follow-up time was 16.4 months (min 1; max 98.4) and, at the end of the follow-up period, most patients (n = 22, 68.8%) were transplanted. The mortality rate was 6.3% (n = 2). In what concerns to the location of the AVF, radiocephalic was the first choice in 46.9% of the cases (n = 15), accounting for 34.9% of the total AVFs. Brachiocephalic location was used in 34.4% (n = 11) of first fistulas and 6 subsequent accesses, accounting for 39.5% of the total AVFs. The brachiobasilic location was chosen in 18.8% (n = 6) of the first AVFs and 25.6% of the total AVFs. Primary AVF failure occurred in 26.6% (n = 11) cases and, in 4 of these (36.4%), it was possible to successfully use the same location for a second AVF. We observed no statistical association between primary AVF failure dysfunction and gender, age at the construction of the first fistula, AVF location, or dialysis vintage. Platelet-lymphocyte (PLR) and neutrophil-lymphocyte (NLR) ratios also did not differ between groups. Primary and secondary patency rates at one year were, respectively, 62.5% and 93.8%. With respect to total AVF complications, we observed: thrombosis (27.9%), stenosis (18.6%), distal ischemia induced by vascular access (4.7%), and high flow/aneurismatic dilations (18.6%). The presence of complications was statistically related to age (p = 0.046), with more events in older patients at the time of AVF construction. There was no statistical difference between complications’ occurrence and AVF type, sex, gender, PLR, and NLR. Conclusion The utilization of AVF for HD has been growingly recognized as a safe and efficient alternative for the performance of KRT in pediatric patients. Although larger studies are needed, we demonstrate positive results in its usage in a pediatric population, with high primary and secondary patency rates. These outcomes were independent of the AVF location. We also advocate AVF usage in younger patients, as complications were associated with older age. PLR and NLR, which are emerging biomarkers for systemic inflammation, were not associated with AVF dysfunction, aligning with the results of other studies in pediatrics.

Background and Aims SARS-CoV-2 represents a challenge for hemodialysis (HD) patients due to their multiple comorbidities, disturbed immune defenses in the setting of kidney disease and increased age. Furthermore, sharing collective spaces during HD sessions increases the risk of contamination. In March 2020, the first COVID-19 cases in Portugal occurred in Felgueiras, a municipality belonging to the district of Porto. The HD unit that serves this population has 69 in-center patients and, from March 2020 until January 2021, has had 14 COVID-19 cases. We describe our experience concerning patient management and their clinical characteristics. Method Clinical and laboratory data were collected. We aimed at assessing the impact of the infection in hemoglobin, alanine transaminase, several electrolytes - potassium, phosphorus, sodium and calcium - as well as the normalized protein catabolic rate (nPCR) comparing results from the month before infection with those of the month after cure. Statistical analysis used SPSS® and variables were compared using paired-samples t-test. Results We used a dedicated room and staff for COVID-19 patients, disinfection protocols and specific routes. Transportation was done with a maximum of 3 patients in a 9-seater vehicle, all patients used masks, practiced social distancing, were asked for symptoms and had their temperature measured on each HD session. SARS-CoV-2 infection was established by reverse transcription polymerase chain reaction on nasal and oropharyngeal swabs. Of the 14 cases, 3 occurred in March, 5 from October until Christmas and 6 from then onwards, accounting for approximately 20% of the unit’s patients. Of these, 2 were asymptomatic, 6 had predominantly respiratory symptoms, 1 had fever and 1 had gastrointestinal symptoms. Three were hospitalized, 2 died due to COVID-19 and 1 died 1 month after cure due to advanced cancer. Mean age of these patients was 70±13.2; 5 were females and 6 had diabetic nephropathy. Only 7 patients had post-COVID-19 results for comparison. The mean hemoglobin value before COVID-19 was 10.5±1.7g/dL and did not change significantly after COVID-19. Although phosphorous dropped from a mean 3.8±0.9mg/dL to 3.2±1.3mg/dL, this difference did not reach significance (p=0.43). All other electrolytes remained stable. nPCR dropped from 1.23±0.47 to 0.95±0.37 although not a significant difference (p=0.24). Five patients were tested for IgG/IgM antibodies against SARS-CoV-2 one month after cure using Elecsys® qualitative immunoassay and 4 tested positive. Conclusion COVID-19 is a problem for HD patients where the percent of cases is larger than in the general population. Our 3 first cases and the 4 last cases shared the same HD shift and occurred in the same period confirming that, despite all protective measures, sharing the facilities in close proximity is a risk factor. Respiratory symptoms predominated but were only severe requiring hospital admission in 3 patients. Mortality represented 14% and the 2 patients whose death was attributable to COVID-19 had an increased burden of comorbidities and were old. Seroconversion was high 1 month after the disease. The only patient who tested negative for antibodies had been asymptomatic raising doubts about whether there could have been false test results or an undetectable immune response.