Background Although vegan-vegetarian diets are increasingly popular, no recent systematic reviews on vegan-vegetarian diets in pregnancy exist.Objectives To review the literature on vegan-vegetarian diets and pregnancy outcomes.Search strategy PubMed, Embase, and the Cochrane library were searched from inception to September 2013 for pregnancy and vegan or vegetarian Medical Subject Headings (MeSH) and freetext terms.Selection criteria Vegan or vegetarian diets in healthy pregnant women. We excluded case reports and papers analysing veganvegetarian diets in poverty and malnutrition. Searching, paper selection, and data extraction were performed in duplicate.Data collection and analysis The high heterogeneity of the studies led to a narrative review.Main results We obtained 262 full texts from 2329 references; 22 selected papers reporting maternal-fetal outcomes (13) and dietary deficiencies (nine) met the inclusion criteria. None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitamin B12 and iron deficiencies.Author's conclusions The evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.

Our data suggest a wider offer of LPD-KA to patients with severe and progressive CKD. The promising results in terms of mortality and progression need confirmation with different study designs.

No abstract

Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

Severe acute respiratory syndrome coronavirus 2 (named SARS CoV-2/COVID-19) is a novel pandemic infectious disease, which emerged in Wuhan, China, in late December 2019 and spread rapidly worldwide. 1,2 At the time we are writing (05/10/2020), in Italy there are about 219 000 patients infected, 28 600 only in Piedmont, our region. 3 Clinically, the disease is characterized with fever, cough, dyspnea, diarrhea, and eventually respiratory failure. 4,5 According to their intrinsic frailty and comorbidities, transplanted patients were considered a high-risk population. 6,7 Tocilizumab (TCZ), a humanized monoclonal antibody against interleukin-6 (IL-6) receptor widely adopted in adult rheumatoid arthritis and also used as rescue therapy for chronic antibody-mediated rejection in kidney transplantation, 8 has been recently registered for the treatment of severe or life-threatening chimeric antigen receptor T-cell induced cytokine release syndrome (CRS) in adult and pediatric patients. 9 In this context, because the development of acute respiratory distress syndrome (ARDS) in COVID-19 pneumonia has been associated with activation of the immune system and consequent cytokine storm with high levels of IL-6, some initial reports suggested a beneficial role of this drug, 10,11 also in solid organ transplanted patients. 12 Herein, we reported our experience in 6 kidney transplanted patients treated with TCZ after occurrence of COVID-19 infection.