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Marques Vidas M, Muñez Rubio E, Quiroga B, Montejano R, Morales E, Candel FJ. Strategies for prevention and treatment of SARS-COV-2 infection in patients with chronic kidney disease: Literature review. Nefrologia 2024; 44:150-158. [PMID: 38575481 DOI: 10.1016/j.nefroe.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
COVID-19 has proven to be particularly aggressive in patients with chronic kidney disease (CKD). The lower immune response rate and the greater susceptibility to progress to severe forms of the disease have contributed to this phenomenon, which has persisted in the post-vaccination era of the pandemic. Paradoxically, CKD has been excluded from most clinical trials of the main therapeutic tools developed against SARS-CoV-2. However, experience in the use of these drugs has been accumulating in different stages of CKD, supporting their use with guarantees of efficacy and safety. The objective of this review is to gather all treatment indications for COVID-19 in the different phases of the disease, tailored to CKD in its various stages, including renal replacement therapy.
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Affiliation(s)
- María Marques Vidas
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Elena Muñez Rubio
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Borja Quiroga
- ISS-La Princesa, Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rocío Montejano
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, CIBER-INFEC, Madrid, Spain
| | - Enrique Morales
- Servicio de Nefrología, Hospital Universitario 12 de Octubre; Instituto de Investigación i+12 del Hospital Universitario 12 de Octubre; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Candel
- Enfermedades Infecciosas y Microbiología Clínica, Coordinación de Trasplantes, Banco de Tejidos, IdISSC, Hospital Universitario Clínico San Carlos, Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Muto M, Sasaki Y, Kano T, Fukao Y, Hosoya R, Nomura T, Sugita M, Io H, Suzuki Y. Successful Management of Critical Acute Respiratory Distress Syndrome following COVID-19 through Extracorporeal Membrane Oxygenation in a Patient with Concurrent Nephrotic Syndrome Relapse. Intern Med 2023; 62:3209-3214. [PMID: 37558472 PMCID: PMC10686741 DOI: 10.2169/internalmedicine.2293-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
A 44-year-old man with coronavirus disease 2019 (COVID-19) and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and immunomodulators, the patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.
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Affiliation(s)
- Masahiro Muto
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yu Sasaki
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Fukao
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Reina Hosoya
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
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Gauckler P, Kesenheimer JS, Geetha D, Odler B, Eller K, Laboux T, Alberici F, Zappa M, Chebotareva N, Moiseev S, Bonilla M, Jhaveri KD, Oniszczuk J, Audard V, Costa D, Mastroianni-Kirsztajn G, Bruchfeld A, Muto M, Windpessl M, Mayer G, Kronbichler A. COVID-19 outcomes in patients with a history of immune-mediated glomerular diseases. Front Immunol 2023; 14:1228457. [PMID: 37767096 PMCID: PMC10520971 DOI: 10.3389/fimmu.2023.1228457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Patients with immune-mediated glomerular diseases are considered at high risk for severe COVID-19 outcomes. However, conclusive evidence for this patient population is scarce. Methods We created a global registry and retrospectively collected clinical data of patients with COVID-19 and a previously diagnosed immune-mediated glomerular disease to characterize specific risk factors for severe COVID-19 outcomes. Results Fifty-nine patients with a history of immune-mediated glomerular diseases were diagnosed with COVID-19 between 01.03.2020 and 31.08.2021. Over a mean follow-up period of 24.79 ± 18.89 days, ten patients (16.9%) developed acute kidney injury. Overall, 44.1% of patients were managed in an outpatient setting and therefore considered as having "non-severe" COVID-19, while 55.9% of patients had severe COVID-19 requiring hospitalization including worse outcomes. Comparing both groups, patients with severe COVID-19 were significantly older (53.55 ± 17.91 versus 39.77 ± 14.95 years, p = .003), had lower serum albumin levels at presentation (3.00 ± 0.80 g/dL versus 3.99 ± 0.68 g/dL, p = .016) and had a higher risk of developing acute kidney injury (27% versus 4%, p = .018). Male sex (p <.001) and ongoing intake of corticosteroids at presentation (p = .047) were also significantly associated with severe COVID-19 outcomes, while the overall use of ongoing immunosuppressive agents and glomerular disease remission status showed no significant association with the severity of COVID-19 (p = .430 and p = .326, respectively). Conclusion Older age, male sex, ongoing intake of corticosteroids and lower serum albumin levels at presentation were identified as risk factors for severe COVID-19 outcomes in patients with a history of various immune-mediated glomerular diseases.
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Affiliation(s)
- Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | | - Duvuru Geetha
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, United States
| | - Balazs Odler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Timothee Laboux
- Nephrology Department, Univ. Lille, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France
- Institut Pasteur de Lille, Univ. Lille, Inserm, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France
| | - Federico Alberici
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Mattia Zappa
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Natasha Chebotareva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marco Bonilla
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States
| | - Kenar D. Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States
| | - Julie Oniszczuk
- Department of Nephrology and Transplantation, Rare French Disease Centre “Idiopathic Nephrotic Syndrome”, Henri-Mondor/Albert-Chenevier Hospital Assistance Publique-Hôpitaux de Paris, Inserm U955, Paris-East University, Créteil, France
| | - Vincent Audard
- Department of Nephrology and Transplantation, Rare French Disease Centre “Idiopathic Nephrotic Syndrome”, Henri-Mondor/Albert-Chenevier Hospital Assistance Publique-Hôpitaux de Paris, Inserm U955, Paris-East University, Créteil, France
| | - Denise Costa
- Department of Nephrology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
- Recife Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Sweden
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine Karolinska Institutet, Stockholm, Sweden
| | - Masahiro Muto
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Martin Windpessl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Waldman M, Sinaii N, Lerma EV, Kurien AA, Jhaveri KD, Uppal NN, Wanchoo R, Avasare R, Zuckerman JE, Liew A, Gallan AJ, El-Meanawy A, Yagil Y, Lebedev L, Baskaran K, Vilayur E, Cohen A, Weerasinghe N, Petrakis I, Stylianou K, Gakiopoulou H, Hamilton AJ, Edney N, Millner R, Marinaki S, Rein JL, Killen JP, Rodríguez Chagolla JM, Bassil C, Lopez del Valle R, Evans J, Urisman A, Zawaideh M, Baxi PV, Rodby R, Vankalakunti M, Mejia Vilet JM, Ramirez Andrade SE, Homan MP, Vásquez Jiménez E, Perinpanayagam N, Velez JCQ, Mohamed MM, Mohammed KM, Sekar A, Ollila L, Aron AW, Arellano Arteaga KJ, Islam M, Berrio EM, Maoujoud O, Morales RR, Seipp R, Schulze CE, Yenchek RH, Vancea I, Muneeb M, Howard L, Caza TN. COVID-19 Vaccination and New Onset Glomerular Disease: Results from the IRocGN2 International Registry. KIDNEY360 2023; 4:349-362. [PMID: 36996301 PMCID: PMC10103269 DOI: 10.34067/kid.0006832022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Key Points IgAN and MCD are the most common de novo glomerular diseases reported after COVID-19 vaccination, particularly after mRNA vaccination. Membranous nephropathy, pauci-immune GN, and collapsing GN have also been attributed to COVID-19 vaccination, some with dual histologies. Recovery of kidney function and proteinuria remission is more likely in IgAN and MCD by 4–6 months compared with the other glomerular diseases. Background Patients with de novo glomerular disease (GD) with various renal histologies have been reported after vaccination against SARS-CoV-2. Causality has not been established, and the long-term outcomes are not known. To better characterize the GDs and clinical courses/outcomes, we created the International Registry of COVID-19 vaccination and Glomerulonephritis to study in aggregate patients with de novo GN suspected after COVID-19 vaccine exposure. Methods A REDCap survey was used for anonymized data collection. Detailed information on vaccination type and timing and GD histology were recorded in the registry. We collected serial information on laboratory values (before and after vaccination and during follow-up), treatments, and kidney-related outcomes. Results Ninety-eight patients with GD were entered into the registry over 11 months from 44 centers throughout the world. Median follow-up was 89 days after diagnosis. IgA nephropathy (IgAN) and minimal change disease (MCD) were the most common kidney diseases reported. Recovery of kidney function and remission of proteinuria were more likely in IgAN and MCD at 4–6 months than with pauci-immune GN/vasculitis and membranous nephropathy. Conclusions The development of GD after vaccination against SARS-CoV-2 may be a very rare adverse event. Temporal association is present for IgAN and MCD, but causality is not firmly established. Kidney outcomes for IgAN and MCD are favorable. No changes in vaccination risk-benefit assessment are recommended based on these findings.
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Affiliation(s)
- Meryl Waldman
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Edgar V. Lerma
- University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Nupur N. Uppal
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rupali Avasare
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jonathan E. Zuckerman
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Adrian Liew
- The Kidney and Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | | | - Ashraf El-Meanawy
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yoram Yagil
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Larissa Lebedev
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Krishoban Baskaran
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan,New South Wales, Australia
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Adrienne Cohen
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nethmi Weerasinghe
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Ioannis Petrakis
- Department of Nephrology, General University Hospital of Heraklion, Crete, Greece
| | | | | | - Alexander J. Hamilton
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Naomi Edney
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Rachel Millner
- Department of Pediatrics, Pediatric Nephrology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece
| | - Joshua L. Rein
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Paul Killen
- Department of Nephrology, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | | | - Claude Bassil
- Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida
- Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | - Jordan Evans
- Department of Nephrology, David Grant Medical Center, Travis Air Force Base, California
| | - Anatoly Urisman
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Mona Zawaideh
- Division of Pediatric Nephrology, Peyton Manning Children's Hospital, Indianapolis, Indiana
| | - Pravir V. Baxi
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | - Roger Rodby
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | | | - Juan M. Mejia Vilet
- Department of Nephrology, Instituto Nacional de Ciencas Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Silvia E. Ramirez Andrade
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Mal P. Homan
- Division of Nephrology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | | | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Muner M.B. Mohamed
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Arjun Sekar
- Rochester General Hospital, Rochester, New York
| | - Laura Ollila
- Helsinki University Central Hospital, Helsinki, Finland
| | - Abraham W. Aron
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin Javier Arellano Arteaga
- Internal Medicine Department, Nuevo Hospital Civil De Guadalajara Dr. Juan I Menchaca, Guadalajara, Mexico; Department of Clinical Medicine, University Center for Health Science, University of Guadalajara
| | - Mahmud Islam
- Division of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Esperanza Moral Berrio
- Department of Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Omar Maoujoud
- Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | | | - Carl E. Schulze
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Robert H. Yenchek
- Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Irina Vancea
- Southern Colorado Nephrology Associates, Pueblo, Colorado
| | | | - Lilian Howard
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Schiffl H, Lang SM. Long-term interplay between COVID-19 and chronic kidney disease. Int Urol Nephrol 2023:10.1007/s11255-023-03528-x. [PMID: 36828919 PMCID: PMC9955527 DOI: 10.1007/s11255-023-03528-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The COVID-19 pandemic may have an impact on the long-term kidney function of survivors. The clinical relevance is not clear. METHODS This review summarises the currently published data. RESULTS There is a bidirectional relationship between chronic kidney disease and COVID-19 disease. Chronic kidney diseases due to primary kidney disease or chronic conditions affecting kidneys increase the susceptibility to COVID-19 infection, the risks for progression and critical COVID-19 disease (with acute or acute-on-chronic kidney damage), and death. Patients who have survived COVID-19 face an increased risk of worse kidney outcomes in the post-acute phase of the disease. Of clinical significance, COVID-19 may predispose surviving patients to chronic kidney disease, independently of clinically apparent acute kidney injury (AKI). The increased risk of post-acute renal dysfunction of COVID-19 patients can be graded according to the severity of the acute infection (non-hospitalised, hospitalised or ICU patients). The burden of chronic kidney disease developing after COVID-19 is currently unknown. CONCLUSION Post-acute COVID-19 care should include close attention to kidney function. Future prospective large-scale studies are needed with long and complete follow-up periods, assessing kidney function using novel markers of kidney function/damage, urinalysis and biopsy studies.
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Affiliation(s)
- Helmut Schiffl
- Universitätsklinikum LMU München, Medizinische Klinik IV, München, Germany.
| | - Susanne M. Lang
- grid.275559.90000 0000 8517 6224Klinik für Innere Medizin V, Universitätsklinikum Jena, Jena, Germany
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Latief M, Mir TH, Wani ML. Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with COVID-19: A Single Center Experience. Indian J Nephrol 2023; 33:50-53. [PMID: 37197050 PMCID: PMC10185014 DOI: 10.4103/ijn.ijn_423_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/15/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients particularly presenting as rapidly progressive glomerulonephritis (RPGN) are at extremely high risk of progressing to end-stage kidney disease (ESKD); therefore, timely intervention is important. We describe our experience of managing six AAV patients who were on treatment (induction phase) and developed COVID-19. Cyclophosphamide was stopped till RT-PCR for SARS-CoV-2 was reported negative and patient had improved symptomatically. Out of our six patients, one died. Subsequently, cyclophosphamide was successfully resumed in all the surviving patients. In patients of AAV with COVID-19, close monitoring and withholding of cytotoxic medication and continuing steroids till active infection subsides is an effective treatment strategy until more and more data from well-conducted largescale studies become available for guidance.
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Affiliation(s)
- Muzamil Latief
- Nephrology Division, Superspeciality Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tajamul H. Mir
- Nephrology Division, Superspeciality Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mohd L. Wani
- Nephrology Division, Superspeciality Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India
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Ota Y, Kuroki R, Iwata M, Taira H, Matsuo S, Kamijo M, Muta K, Nishino T. Association between COVID-19 vaccination and relapse of glomerulonephritis. Clin Exp Nephrol 2023; 27:236-242. [PMID: 36422760 PMCID: PMC9686234 DOI: 10.1007/s10157-022-02299-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaccines for coronavirus disease 2019 (COVID-19) have been developed and are recommended for patients with chronic kidney disease; however, it has been reported that glomerulonephritis worsens after vaccination. We aimed to elucidate the incidence and association between COVID-19 vaccination and glomerulonephritis relapse. METHODS We investigated the onset of renal events and adverse reactions after COVID-19 vaccination in 111 patients diagnosed with glomerulonephritis. Renal events were defined as worsening hematuria, increased proteinuria, and an increased creatine level over 1.5-fold from baseline. RESULTS Patients were 57 ± 18 years old (55.9% female) and had an estimated glomerular filtration rate of 57.0 ± 25.0 ml/min/1.73 m2. A pathological diagnosis of IgA nephropathy was confirmed in 55.0%, minimal change disease in 22.5%, and membranous nephropathy in 10.8% of the patients. The BNT162b2 (Pfizer) and mRNA-1273 (Moderna) vaccines were administered in 88.2% and 11.7% of the cases, respectively. Renal events were observed in 22.5% of patients, 10.8% had increased proteinuria, 12.6% had worsening hematuria, and 1.8% received additional immunosuppressive treatment. Only 0.9% required temporary hemodialysis from exacerbation of renal dysfunction. Renal events were higher in younger patients (P = 0.02), being highest in those with IgA nephropathy, but there was no difference in the incidence between pathological diagnoses. There was a significantly higher incidence of renal events in patients with fever (P = 0.02). CONCLUSIONS COVID-19 vaccination and glomerulonephritis relapse may be related, but further research is needed.
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Affiliation(s)
- Yuki Ota
- Department of Nephrology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, Nagasaki, 857-8511, Japan.
| | - Ryoma Kuroki
- Department of Nephrology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, Nagasaki 857-8511 Japan
| | - Mayu Iwata
- Department of Nephrology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, Nagasaki 857-8511 Japan
| | - Hiroshi Taira
- Department of Nephrology, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, Nagasaki 850-0003 Japan
| | - Sayumi Matsuo
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501 Japan
| | - Masafumi Kamijo
- Department of Nephrology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, Nagasaki 857-8511 Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501 Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501 Japan
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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9
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Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol 2022; 18:724-737. [PMID: 36002770 PMCID: PMC9400561 DOI: 10.1038/s41581-022-00618-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
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Affiliation(s)
- Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Megan Rutter
- Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shuchi Anand
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA
| | - Eugene Lin
- Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Stephen Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Fowler
- Principal, Voice of the Patient Inc, St. Louis, Missouri, USA
| | - Ray Bignall
- Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Robert Hoover
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Deidra Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Chirag Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Nephrologist, University Childrens Hospital, Zurich, Switzerland
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10
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Antovic A, Bruchfeld A, Ekland J, Lövström B, Hugelius A, Börjesson O, Knight A, Gunnarsson I. Risks and treatment related aspects of COVID-19 infection in patients with ANCA-associated vasculitis. Scand J Rheumatol 2022:1-6. [PMID: 36124819 DOI: 10.1080/03009742.2022.2109337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) require immunosuppressive therapy for disease control and relapse prevention and may be at risk for severe coronavirus disease 2019 (COVID-19). The study objective was to analyse risk factors and outcomes of COVID-19 in well-characterized AAV patients. METHOD Data were retrieved from March 2020 to May 2021 from medical records of AAV cohorts in Stockholm and Uppsala, Sweden. COVID-19 was confirmed by positive PCR test or by ELISA. Severe COVID-19 was defined as need for non-invasive ventilation, intensive care unit care, and/or death. Age, gender, ANCA antibody type, ongoing immunosuppressive medication, and estimated glomerular filtration rate were recorded. RESULTS The cohort comprised 310 AAV patients, of whom 29 (9%) were diagnosed with COVID-19. Four deaths were attributed to COVID-19. Fifteen patients (52%) were on prednisolone in the COVID-19 group and 130 (46%) in the non-COVID group, with significantly higher doses in COVID-19 patients (p < 0.01). Ongoing induction therapy was more prevalent in the COVID-19 group (p < 0.01). Severe COVID-19 was diagnosed in 9/29 (31%). Significant risk factors for severe COVID-19 were impaired kidney function (p = 0.01) and more intense immunosuppressive therapy (p = 0.02), with a trend for age (p = 0.07). Maintenance therapy with rituximab was not associated with severe COVID-19. CONCLUSIONS Our findings highlight risks and suggest that more attention should be given to optimal AAV treatment in a pandemic situation. They also emphasize the need for continued shielding, mitigation strategies, and effective vaccination of AAV patients.
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Affiliation(s)
- A Antovic
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Renal Medicine, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - J Ekland
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - B Lövström
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Hugelius
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - O Börjesson
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Knight
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - I Gunnarsson
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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11
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Morioka F, Nakatani S, Tsuda A, Mori K, Emoto M. Successful alternative vaccination with BNT162b2 mRNA COVID-19 vaccine for new-onset IgA vasculitis after receiving mRNA-1273—case report. CEN Case Rep 2022; 11:511-512. [PMID: 36114985 PMCID: PMC9483241 DOI: 10.1007/s13730-022-00735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/04/2022] [Indexed: 11/02/2022] Open
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12
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Turner-Stokes T, Edwards H, Lightstone L. COVID-19 in patients with glomerular disease. Curr Opin Nephrol Hypertens 2022; 31:191-198. [PMID: 34923542 DOI: 10.1097/mnh.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Managing patients with glomerular disease during the COVID-19 pandemic has been challenging, as the infection risk associated with immunosuppression must be balanced against the need to control severe glomerular disease that can lead to kidney failure. This review provides an overview of COVID-19 and the effectiveness of SARS-CoV-2 vaccination in patients with glomerular disease. RECENT FINDINGS Registry data, although biased towards outcomes of hospitalized patients, suggest that the mortality from COVID-19 is higher in patients with glomerular disease than in the general population. Glucocorticoid use prior to SARS-CoV-2 infection is associated with adverse outcomes from COVID-19. Rituximab significantly attenuates serological responses to both natural infection and vaccination against SARS-CoV-2, although it is not clear whether this leads to adverse outcomes. Case reports of disease flares occurring after vaccination have been reported, but causality in any of these cases has yet to be proven and the absolute risk remains very small. SUMMARY Patients with glomerular disease represent an at-risk group for severe COVID-19 disease and vaccination is key to reducing this risk. As immunosuppressed patients demonstrate an attenuated response to vaccination, the efficacy of a third primary dose followed by a subsequent booster is being investigated.
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Affiliation(s)
- Tabitha Turner-Stokes
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Helena Edwards
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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13
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Stevens KI, Frangou E, Shin JIL, Anders HJ, Bruchfeld A, Schönermarck U, Hauser T, Westman K, Fernandez-Juarez GM, Floege J, Goumenos D, Turkmen K, van Kooten C, McAdoo SP, Tesar V, Segelmark M, Geetha D, Jayne DRW, Kronbichler A. OUP accepted manuscript. Nephrol Dial Transplant 2022; 37:1400-1410. [PMID: 35244174 PMCID: PMC9383521 DOI: 10.1093/ndt/gfac052] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Jae I l Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Ulf Schönermarck
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Kerstin Westman
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | | | - Jürgen Floege
- Division of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, Patras University Hospital, Patras, Greece
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cees van Kooten
- Division of Nephrology and Transplant Medicine, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
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14
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Bjornstad EC, Seifert ME, Sanderson K, Feig DI. Kidney implications of SARS-CoV2 infection in children. Pediatr Nephrol 2022; 37:1453-1467. [PMID: 34453600 PMCID: PMC8397606 DOI: 10.1007/s00467-021-05249-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
Research indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can impact every organ, and the effects can range from asymptomatic to severe disease. Since it was first discovered in December 2019, our understanding has grown about its impact on kidney disease. In general, children have less severe disease than adults, and this tendency appears to extend to special pediatric kidney populations (e.g., chronic kidney disease and immunosuppressed patients with solid organ transplants or nephrotic syndrome). However, in a fraction of infected children, SARS-CoV2 causes an array of kidney manifestations, ranging from acute kidney injury to thrombotic microangiopathy, with potential implications for increased risk of morbidity and mortality. Additional considerations surround the propensity for clotting extracorporeal circuits in children with SARS-CoV2 infection that are receiving kidney replacement therapy. This review provides an update on our current understanding of SARS-CoV2 for pediatric nephrologists and highlights knowledge gaps to be addressed by future research during this ongoing pandemic, particularly the social disparities magnified during this period.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael E Seifert
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keia Sanderson
- Department of Medicine, Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel I Feig
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Stauss M, Dhaygude A, Ponnusamy A, Myers M, Woywodt A. Remote Digital Urinalysis With Smartphone Technology as Part of Remote Management of Glomerular Disease During the SARS-CoV-2 Virus Pandemic: Single Centre Experience in 25 Patients. Clin Kidney J 2021; 15:903-911. [PMID: 35498887 PMCID: PMC9050594 DOI: 10.1093/ckj/sfab286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 pandemic has necessitated the provision of healthcare through remote and increasingly digitalized means. The management of glomerular pathology, for which urinalysis is crucial, has been notably affected. Here we describe our single-centre experience of using remote digital urinalysis in the management of patients with glomerular disease during the COVID-19 pandemic. Method All patients with native kidney glomerular disease who consented to participate in digital smartphone urinalysis monitoring between March 2020 and July 2021 were included. Electronic health records were contemporaneously reviewed for outcome data. Patient feedback was obtained through the testing portal. Results Twenty-five patients utilized the digital urinalysis application. A total of 105 digital urinalysis tests were performed for a wide variety of indications. Four patients experienced a relapse (detected remotely) and two patients underwent three successful pregnancies. The majority of patients were managed virtually (60%) or virtually and face to face (F2F) combined (32%). The average number of clinic reviews and urine tests performed during the pandemic either virtually and/or F2F was comparable to levels pre-pandemic and the ratio of reviews to urinalysis (R:U) was stable (pre-pandemic 1:0.9 versus during the pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. A total of 95% of users provided feedback, all positive. Conclusion Remote urinalysis proved a safe and convenient tool to facilitate decision-making where traditional urinalysis was difficult, impractical or impossible. Our approach allowed us to continue care in this vulnerable group of patients despite a lack of access to traditional urinalysis.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Ajay Dhaygude
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Arvind Ponnusamy
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Martin Myers
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Division of Medical Education, School of Medical Sciences, University of Manchester
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16
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Waldman M, Soler MJ, García-Carro C, Lightstone L, Turner-Stokes T, Griffith M, Torras J, Martinez Valenzuela L, Bestard O, Geddes C, Flossmann O, Budge KL, Cantarelli C, Fiaccadori E, Delsante M, Morales E, Gutierrez E, Niño-Cruz JA, Martinez-Rueda AJ, Comai G, Bini C, La Manna G, Slon MF, Manrique J, Avello A, Fernandez-Prado R, Ortiz A, Marinaki S, Martin Varas CR, Rabasco Ruiz C, Sierra-Carpio M, García-Agudo R, Fernández Juárez G, Hamilton AJ, Bruchfeld A, Chrysochou C, Howard L, Sinha S, Leach T, Agraz Pamplona I, Maggiore U, Cravedi P. COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry. KIDNEY360 2021; 3:293-306. [PMID: 35373130 PMCID: PMC8967646 DOI: 10.34067/kid.0006612021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023]
Abstract
Background The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Maria Jose Soler
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara García-Carro
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, United Kingdom,Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Tabitha Turner-Stokes
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, United Kingdom,Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Megan Griffith
- Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Joan Torras
- Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Martinez Valenzuela
- Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Bestard
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Kelly L. Budge
- Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chiara Cantarelli
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Fiaccadori
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marco Delsante
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrique Morales
- Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Eduardo Gutierrez
- Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Jose A. Niño-Cruz
- Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando J. Martinez-Rueda
- Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | - Claudia Bini
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | | | | | - Alejandro Avello
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Raul Fernandez-Prado
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece
| | | | | | | | - Rebeca García-Agudo
- Nephrology Department La Mancha-Centro Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Constantina Chrysochou
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Lilian Howard
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Smeeta Sinha
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Tim Leach
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Irene Agraz Pamplona
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Cravedi
- Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
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17
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Kronbichler A, Jung SY, Kim MS, Shin JI. Distinct glomerular disease association after vaccination with BNT162b2 and mRNA-1273: a VigiBase analysis. Kidney Int 2021; 101:415-416. [PMID: 34822875 PMCID: PMC8606315 DOI: 10.1016/j.kint.2021.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022]
Affiliation(s)
| | - Se Yong Jung
- Department of Pediatrics, Division of Pediatric Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Seo Kim
- Samsung Advances Institute for Health Sciences and Technology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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18
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Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients. Int Urol Nephrol 2021; 54:1551-1563. [PMID: 34811606 PMCID: PMC8608362 DOI: 10.1007/s11255-021-03059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is associated with increased mortality in patients with chronic kidney disease (CKD), dialysis patients and kidney transplant recipients (KTR). Cardiovascular complications, such as sudden arrhythmias, thromboembolic events, coronary events, cardiomyopathies and heart failure, may present in about 10–20% of patients with COVID-19. Patients with CKD, dialysis patients and KTR are all at increased cardiovascular risk and present with more cardiovascular complications after COVID-19 compared to the general population. During the pandemic, health care giving has rapidly changed by reducing elective outpatient reviews, which may refrain these high-risk patients from the appropriate management of their medical conditions, further increasing cardiovascular risk. Importantly, acute kidney injury (AKI) is another common complication of severe COVID-19 and associates with increased mortality. A large proportion of the AKI patients need renal replacement treatment, while 30% of them may not present renal function recovery and remain dialysis-dependent after discharge, thereby having potentially increased future cardiovascular risk. This review summarizes current knowledge regarding the cardiovascular events and mortality in patients with CKD or undergoing hemodialysis and in KTR.
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19
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Román JL, Vergara A, Agraz I, García-Carro C, Bermejo S, Gabaldón A, Soler MJ. Focal and segmental glomerulosclerosis associated with COVID-19 infection. Nefrologia 2021; 41:706-708. [PMID: 36165163 PMCID: PMC8769713 DOI: 10.1016/j.nefroe.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 05/31/2023] Open
Affiliation(s)
- Juan León Román
- Nefrología, Hospital Universitario de Vall d´Hebrón, Barcelona, Spain
| | - Ander Vergara
- Nefrología, Hospital Universitario de Vall d´Hebrón, Barcelona, Spain
| | - Irene Agraz
- Nefrología, Hospital Universitario de Vall d´Hebrón, Barcelona, Spain
| | | | - Sheila Bermejo
- Nefrología, Hospital Universitario de Vall d´Hebrón, Barcelona, Spain
| | | | - María José Soler
- Nefrología, Hospital Universitario de Vall d´Hebrón, Barcelona, Spain.
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20
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Prendecki M, Clarke C, Edwards H, McIntyre S, Mortimer P, Gleeson S, Martin P, Thomson T, Randell P, Shah A, Singanayagam A, Lightstone L, Cox A, Kelleher P, Willicombe M, McAdoo SP. Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression. Ann Rheum Dis 2021; 80:1322-1329. [PMID: 34362747 PMCID: PMC8350975 DOI: 10.1136/annrheumdis-2021-220626] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is an urgent need to assess the impact of immunosuppressive therapies on the immunogenicity and efficacy of SARS-CoV-2 vaccination. METHODS Serological and T-cell ELISpot assays were used to assess the response to first-dose and second-dose SARS-CoV-2 vaccine (with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccines) in 140 participants receiving immunosuppression for autoimmune rheumatic and glomerular diseases. RESULTS Following first-dose vaccine, 28.6% (34/119) of infection-naïve participants seroconverted and 26.0% (13/50) had detectable T-cell responses to SARS-CoV-2. Immune responses were augmented by second-dose vaccine, increasing seroconversion and T-cell response rates to 59.3% (54/91) and 82.6% (38/46), respectively. B-cell depletion at the time of vaccination was associated with failure to seroconvert, and tacrolimus therapy was associated with diminished T-cell responses. Reassuringly, only 8.7% of infection-naïve patients had neither antibody nor T-cell responses detected following second-dose vaccine. In patients with evidence of prior SARS-CoV-2 infection (19/140), all mounted high-titre antibody responses after first-dose vaccine, regardless of immunosuppressive therapy. CONCLUSION SARS-CoV-2 vaccines are immunogenic in patients receiving immunosuppression, when assessed by a combination of serology and cell-based assays, although the response is impaired compared with healthy individuals. B-cell depletion following rituximab impairs serological responses, but T-cell responses are preserved in this group. We suggest that repeat vaccine doses for serological non-responders should be investigated as means to induce more robust immunological response.
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Affiliation(s)
- Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Candice Clarke
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Helena Edwards
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Stacey McIntyre
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Paige Mortimer
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Sarah Gleeson
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Martin
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Tina Thomson
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Anand Shah
- Respiratory Medicine, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Aran Singanayagam
- Department of Infectious Diseases, Imperial College London, London, UK
- Department of Respiratory Medicine, Harefield Hospital, London, UK
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Alison Cox
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Peter Kelleher
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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21
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Garcia GE, Truong LD, Johnson RJ. Angiotensin-converting enzyme 2 decreased expression during kidney inflammatory diseases: implications to predisposing to COVID-19 kidney complications. Kidney Int 2021; 100:1138-1140. [PMID: 34474076 PMCID: PMC8404374 DOI: 10.1016/j.kint.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/22/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Gabriela E Garcia
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Luan D Truong
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA; Department of Pathology, The Methodist Hospital, Houston, Texas, USA
| | - Richard J Johnson
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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22
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Carr EJ, Kronbichler A, Graham-Brown M, Abra G, Argyropoulos C, Harper L, Lerma EV, Suri RS, Topf J, Willicombe M, Hiremath S. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6:2292-2304. [PMID: 34250319 PMCID: PMC8257418 DOI: 10.1016/j.ekir.2021.06.027] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
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Affiliation(s)
| | | | | | - Graham Abra
- Satellite Healthcare, San Jose, California, USA
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Rita S. Suri
- Research Institute, University Health Center, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Detroit, Michigan, USA
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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23
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Salas A, Kant S, Floyd L, Kratky V, Brix SR, Prendecki M, Schönermarck U, Scott J, Saha M, Gauckler P, Li T, Sharma PD, Ayoub I, Morris AD, Dhaygude AP, Hruskova Z, Tesar V, McAdoo SP, Little MA, Derebail VK, Poulton CJ, Seo P, Kronbichler A, Geetha D. ANCA Vasculitis Induction Management During the COVID-19 Pandemic. Kidney Int Rep 2021; 6:2903-2907. [PMID: 34426797 PMCID: PMC8373584 DOI: 10.1016/j.ekir.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Antonio Salas
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren Floyd
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Vojtěch Kratky
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Silke R Brix
- Renal, Urology and Transplantation Unit, Manchester University Hospitals, Manchester, UK
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Manish Saha
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Tingting Li
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Purva D Sharma
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Isabelle Ayoub
- Department of Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam D Morris
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay P Dhaygude
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Zdenka Hruskova
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Vimal K Derebail
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Caroline J Poulton
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Philip Seo
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Duvuru Geetha
- Division of Nephrology and Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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24
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Shimmel A, Shaikhouni S, Mariani L. Current Understanding of Clinical Manifestations of COVID-19 in Glomerular Disease. GLOMERULAR DISEASES 2021; 1:250-264. [PMID: 36747902 PMCID: PMC8450860 DOI: 10.1159/000518276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Background The novel coronavirus disease (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving pandemic with significant mortality. Information about the impact of infection on glomerular disease patients in particular has been lacking. Understanding the virus's effect in glomerular disease is constantly changing. This review article summarizes the data published thus far on COVID-19 and its manifestations in pre-existing and de novo glomerular disease. Summary While patients with glomerular disease may be at higher risk of severe COVID-19 due to their immunosuppressed status, some data suggest that a low amount of immunosuppression may be helpful in mitigating the systemic inflammatory response which is associated with high mortality rates in COVID-19. There have been a few case reports on COVID-19 causing glomerular disease relapse in patients. Multiple mechanisms have been proposed for kidney injury, proteinuria, and hematuria in the setting of COVID-19. More commonly, these are caused by direct tubular injury due to hemodynamic instability and hypoxic injury. However, the cytokine storm induced by COVID-19 may trigger common post-viral glomerular disease such as IgA nephropathy, anti-GBM, and ANCA vasculitis that have also been described in COVID-19 patients. Collapsing glomerulopathy, a hallmark of HIV-associated nephropathy, is being reported SARS-CoV-2 cases, particularly in patients with high-risk APOL1 alleles. Direct viral invasion of glomerular structures is hypothesized to cause a podocytopathy due to virus's affinity to ACE2, but evidence for this remains under study. Key Messages Infection with SARS-CoV-2 may cause glomerular disease in certain patients. The mechanism of de novo glomerular disease in the setting of COVID-19 is under study. The management of patients with existing glomerular disease poses unique challenges, especially with regard to immunosuppression management. Further studies are needed to inform clinician decisions about the management of these patients during the COVID-19 pandemic.
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Affiliation(s)
- Allison Shimmel
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Salma Shaikhouni
- Department of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Laura Mariani
- Department of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA,*Laura Mariani,
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25
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Tang H, Tu C, Xiong F, Sun X, Tian JB, Dong JW, Wang XH, Lei CT, Liu J, Zhao Z, Qiu Y, Miao XP, Zhang C. Risk factors for the mortality of hemodialysis patients with COVID-19: A multicenter study from the overall hemodialysis population in Wuhan. Semin Dial 2021; 35:71-80. [PMID: 34137080 PMCID: PMC8447194 DOI: 10.1111/sdi.12995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/07/2021] [Accepted: 05/11/2021] [Indexed: 12/20/2022]
Abstract
Introduction Maintenance hemodialysis (MHD) patients are highly threatened in the novel coronavirus disease 2019 (COVID‐19) pandemic, but evidence of risk factors for mortality in this population is still lacking. Methods We followed outcomes of the overall MHD population of Wuhan, including 7154 MHD patients from 65 hemodialysis centers, from January 1 to May 4, 2020. Among them, 130 were diagnosed with COVID‐19. The demographic and clinical data of them were collected and compared between survivors and nonsurvivors. Results Compared to the corresponding period of last year, the all‐cause mortality rate of the Wuhan MHD population significantly rose in February, and dropped down in March 2020. Of the 130 COVID‐19 cases, 51 (39.2%) were deceased. Advanced age, decreased oxygen saturation, low diastolic blood pressure (DBP) on admission, and complications including acute cardiac injury (HR 5.03 [95% CI 2.21–11.14], p < 0.001), cerebrovascular event (HR 2.80 [95% CI 1.14–6.86], p = 0.025) and acute respiratory distress syndrome (HR 3.50 [95% CI 1.63–7.51], p = 0.001) were identified as independent risk factors for the death of COVID‐19. The median virus shedding period of survivors was 25 days, longer than the general population. Conclusions Maintenance hemodialysis patients are a highly vulnerable population at increased risk of mortality and prolonged virus shedding period in the ongoing COVID‐19 pandemic. Advanced age, decreased oxygen saturation, low DBP on admission, and complications like acute cardiac injury are parameters independently associated with poor prognosis.
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Affiliation(s)
- Hui Tang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Can Tu
- Department of Nephrology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,The Second Affiliated Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Fei Xiong
- Department of Nephrology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Sun
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-Bo Tian
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Wu Dong
- Department of Nephrology, Wuhan Fourth Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Hui Wang
- Department of Nephrology, Wuhan Fifth Hospital, Wuhan, China
| | - Chun-Tao Lei
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Zhao
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Qiu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ping Miao
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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26
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Bruchfeld A, Kronbichler A, Alberici F, Fervenza FC, Jayne DRW, Segelmark M, Tesar V, Szpirt WM. COVID-19 and ANCA-associated vasculitis - recommendations for vaccine preparedness and the use of rituximab. Nephrol Dial Transplant 2021; 36:1758-1760. [PMID: 33944946 PMCID: PMC8136000 DOI: 10.1093/ndt/gfab174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.,Department of Medicine, University of Cambridge, CB2 0QQ, United Kingdom
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia, Brescia, Italy; Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - David R W Jayne
- Department of Medicine, University of Cambridge, CB2 0QQ, United Kingdom
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Lund University, Nephrology, Lund, Sweden
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Wladimir M Szpirt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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27
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LeónRomán J, Vergara A, Agraz I, García-Carro C, Bermejo S, Gabaldón A, Soler MJ. Focal and segmental glomerulosclerosis associated with COVID-19 infection. Nefrologia 2021; 41:S0211-6995(21)00058-8. [PMID: 33888348 PMCID: PMC8054222 DOI: 10.1016/j.nefro.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Juan LeónRomán
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | - Ander Vergara
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | - Irene Agraz
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | | | - Sheila Bermejo
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | | | - María José Soler
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España.
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28
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Ferretti F, Cannatelli R, Benucci M, Carmagnola S, Clementi E, Danelli P, Dilillo D, Fiorina P, Galli M, Gallieni M, Genovese G, Giorgi V, Invernizzi A, Maconi G, Maier JA, Marzano AV, Morpurgo PS, Nebuloni M, Radovanovic D, Riva A, Rizzardini G, Sabiu G, Santus P, Staurenghi G, Zuccotti G, Sarzi-Puttini PC, Ardizzone S. How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group. Front Immunol 2021; 12:656362. [PMID: 33936084 PMCID: PMC8082137 DOI: 10.3389/fimmu.2021.656362] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.
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Affiliation(s)
- Francesca Ferretti
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Rosanna Cannatelli
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Stefania Carmagnola
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Scientific Institute IRCCS E. Medea, Lecco, Italy
| | - Piergiorgio Danelli
- Surgery Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Ospedale dei Bambini, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli - Sacco, Milan, Italy.,International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università Degli Studi di Milano, Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, III Infectious Diseases unit, University Hospital "Luigi Sacco", Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, "L. Sacco" Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Giovanni Genovese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia
| | - Giovanni Maconi
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Jeanette A Maier
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Angelo V Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Paola S Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Manuela Nebuloni
- Pathology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy.,School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Gianmarco Sabiu
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, "L. Sacco" Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Ospedale dei Bambini, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Pier Carlo Sarzi-Puttini
- Rheumatology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
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29
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Kronbichler A, Anders HJ, Fernandez-Juárez GM, Floege J, Goumenos D, Segelmark M, Tesar V, Turkmen K, van Kooten C, Bruchfeld A. Recommendations for the use of COVID-19 vaccines in patients with immune-mediated kidney diseases. Nephrol Dial Transplant 2021; 36:gfab064. [PMID: 33693778 PMCID: PMC7989374 DOI: 10.1093/ndt/gfab064] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Coronavirus Disease 19 (COVID-19) vaccine platforms are becoming available and are the most promising strategy to curb the spread of SARS-CoV-2 infections. However, numerous uncertainties exist regarding the pros and cons of vaccination, especially in patients with (immune-mediated) kidney diseases on immunosuppressive drugs. Here, members of the Immunonephrology Working Group (IWG) of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) discuss thirteen frequently-asked questions regarding safety and efficacy of the most promising vaccine candidates. Post-marketing surveillance should be performed to estimate the rate of vaccine response (humoral and cellular) of different vaccine platforms, and surveillance of disease activity following administration of COVID-19 vaccines. Some of the candidates induce signaling pathways which also promote autoimmune kidney diseases, e.g. type I interferons in systemic lupus erythematosus. Efficacy estimates would thus far favor the use of selected COVID-19 vaccines, such as BNT162b2, mRNA-1273 or Gam-COVID-Vac. Humoral immune response after vaccination should be monitored using appropriate assays. Even in the absence of neutralizing antibodies patients might be protected by a sufficient cellular immune response capable to reduce severity of COVID-19. A reduced vaccine response after the use of CD20-depleting agents is anticipated, and it is particularly important to discuss strategies to improve vaccine response with these patients. Distancing and shielding measures remain important as not all vaccines fully protect from coronavirus infection. In-depth information about the most pressing vaccine questions is essential to reduce vaccine hesitancy of patients.
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Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Hans-Joachim Anders
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Munich, Germany
| | | | - Jürgen Floege
- Division of Nephrology, RTWH Aachen University Hospital, Aachen, Germany
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, Patras University Hospital, Patras, Greece
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cees van Kooten
- Division of Nephrology and Transplant Medicine, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette Bruchfeld
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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30
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Sanchez-Russo L, Billah M, Chancay J, Hindi J, Cravedi P. COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences. J Clin Med 2021; 10:900. [PMID: 33668833 PMCID: PMC7956338 DOI: 10.3390/jcm10050900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
Acute kidney injury (AKI) is a common finding in patients with coronavirus disease 2019 (COVID-19) and has been associated with higher rates of death when compared to COVID-19 patients without kidney injury. Whereas the definitive pathogenesis of COVID-19-related AKI (CoV-AKI) is not clear, histopathologic evidence seems to point at multiple etiologies for the disease, including indirect and direct viral kidney injury. The high incidence of CoV-AKI, along with the aggressive clinical presentation of this entity, have increased the demands for kidney replacement therapies, rapidly overwhelming the supplies of healthcare systems even in major tertiary care centers. As a result, nephrologists have come up with alternatives to maximize the efficiency of treatments and have developed non-conventional therapeutic alternatives such as the implementation of acute peritoneal dialysis for critically ill patients. The long-term implications of CoV-AKI are yet unknown, though early studies suggest that around one third of the patients who survive will remain dependent on kidney replacement therapy. Nephrologists and healthcare workers need to be familiar with the clinical presentation and therapeutic challenges of CoV-AKI in order to develop strategies to mitigate the burden of the disease for patients, and for services providing kidney replacement therapies.
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Affiliation(s)
| | | | | | | | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (L.S.-R.); (M.B.); (J.C.); (J.H.)
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31
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Brix SR, Jones RB, Jayne DRW. Glomerular basement membrane nephritis: crescentic renal inflammation and immunosuppressive intervention in the time of the severe acute respiratory syndrome coronavirus 2 pandemic. Kidney Int 2021; 99:1234-1235. [PMID: 33581197 PMCID: PMC7875705 DOI: 10.1016/j.kint.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Silke R Brix
- Renal, Urology and Transplantation Unit, Manchester University Hospitals, Manchester, UK.
| | - Rachel B Jones
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - David R W Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
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