De novo collapsing glomerulopathy after kidney transplantation: Description of two cases.

BACKGROUND: Among different forms of de novo focal segmental glomerulosclerosis (FSGS), which can develop after kidney transplantation (KTx), collapsing glomerulopathy (CG) is the least frequent variant, but it is associated with the most severe form of nephrotic syndrome, histological findings of important vascular damage, and a 50% risk of graft loss. Here, we report two cases of de novo post-transplant CG. CLINICAL PRESENTATION: A 64-year-old White man developed proteinuria and worsening of renal function 5 years after KTx. Before the KTx, the patient was affected by an uncontrolled resistant hypertension, despite multiple antihypertensive therapies. Blood levels of calcineurin inhibitors (CNIs) were stable, with intermittent peaks. Kidney biopsy showed the presence of CG. After introduction of angiotensin receptor blockers (ARBs), urinary protein excretion progressively decreased in 6 months, but subsequent follow-up confirmed a progressive renal function decline. A 61-year-old White man developed CG 22 years after KTx. In his medical history, he was hospitalized twice to manage uncontrolled hypertensive crises. In the past, basal serum cyclosporin A levels were often detected above the therapeutic range. Low doses of intravenous methylprednisolone were administered due to the histological inflammatory signs shown on renal biopsy, followed by a rituximab infusion as a rescue therapy, but no clinical improvement was seen. DISCUSSION AND CONCLUSION: These two cases of de novo post-transplant CG were supposed to be mainly caused by the synergic effect of metabolic factors and CNI nephrotoxicity. Identifying the etiological factors potentially responsible for de novo CG development is essential for an early therapeutic intervention and the hope of better graft and overall survival.

Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (COVID-19).

During the novel coronavirus pandemic, organ transplant recipients represent a frail susceptible category due to long-term immunosuppressive therapy. For this reason, clinical manifestations may differ from general population and different treatment approaches may be needed. We present the case of a 36-year-old kidney-transplanted woman affected by Senior-Loken syndrome diagnosed with COVID-19 pneumonia after a contact with her positive mother. Initial symptoms were fatigue, dry cough, and coryza; she never had fever nor oxygen supplementation. Hydroxychloroquine and lopinavir/ritonavir were started, and the antiviral drug was replaced with darunavir/cobicistat after 2 days for diarrhea. Immunosuppressant levels were closely monitored, and we observed very high tacrolimus trough levels despite initial dose reduction. The patient was left with steroid therapy alone. The peculiarity of clinical presentation and the management difficulties represent the flagship of our case report. We stress the need for guidelines in transplant recipients with COVID-19 infection with particular regard to the management of therapy.

How to improve quality of life in patients with chronic kidney disease: a personal view.

The quality of life (QoL) of patients affected with chronic kidney disease (CKD) is clearly diminished, especially at the dialysis or renal transplantation stage. To find an equilibrium and improve his/her QoL, the patient should be active and positive regarding his/her own disease. The patient's disease profoundly affects the QoL of spouse and family. The patient and his family are in permanent need of more knowledge and information about the disease. Health professionals should be aware of all these consequences and try to help/advise the patient to reach the goal of a better daily life in his/her own environment.

Sleep disorders occur very early in chronic kidney disease.

BACKGROUND: Recent data suggest that sleep disorders may be common in patients with end-stage renal disease (ESRD) and patients with pre-dialytic chronic kidney disease (CKD). The prevalence of sleep disorders in CKD, its association to kidney function and related factors is still unclear. This study aimed to measure the prevalence of sleep disorders in patients with recent diagnosis of CKD and to assess the relation with indices of kidney function, PTH, anemia, blood pressure status, antihypertensive drug(s) and other comorbidities. METHODS: A standardized questionnaire, Sleep Disorders Questionnaire (SDQ) was administered to 124 patients within 4 weeks of first diagnosis of CKD. Blood samples were analyzed to assess kidney function and related variables. Charlson Comorbidity Index was used to index the number of associated diseases. RESULTS: Of these patients 89.5% reported some sleep disorders (subclinical or insomnia). Prevalence of sleep disorders was not associated with age, creatinine plasma concentration, urea, predicted creatinine clearance, uric acid, PTH, blood pressure status, use of antihypertensive drugs, anemia, and comorbidities. Poor sleep is highly prevalent in early CKD patients. Prevalence of sleep disorders in CKD was not associated with factors considered responsible for sleep disorders in maintenance hemodialysis. CONCLUSIONS: The data are in good keeping with findings in narrative studies in ESRD pointing out that the time of diagnosis is a crucial and disrupting moment in the life of patients since they are made aware of significant future personal changes due to a chronic illness.

High prevalence of sleep disorders at the time of CKD diagnosis.

OBJECTIVE: Sleep disorders are very common in adult and children on maintenance hemodialysis and are not cured by renal transplantation. SETTING/DESIGN: Studies in our laboratory of patients with a mean plasma creatinine concentration of 2 mg/dL, studied within 2 months of chronic kidney disease (CKD) diagnosis, have detected a high prevalence of sleep disorders that could not be explained by using the factors prevalent in hemodialysis patients. MAIN OUTCOME MEASURES: To understand if the intrusiveness of the disease is a cause for the high prevalence of sleep disorders in early CKD, we have assessed, by means of a questionnaire, sleep disorders within 1 month from the diagnosis of renal dysfunction. RESULTS: A total of 100 CKD patients with a mean estimated creatinine clearance of 59.1 +/- 26.7 mL/min were studied. The prevalence of sleep disorders was 89%. CONCLUSION: We believe this high prevalence might represent the effects of disease's intrusiveness and difficulty in coping with the disease.

Sleeping disorders in patients with end-stage renal disease and chronic kidney disease.

About 85% of patients on maintenance hemodialysis have sleep disorders that depend on comorbidities, age, morning dialytic shift, and blood pressure. They are ameliorated by erythropoietin, by transplantation, and by daily and nocturnal dialysis. Some data exist on sleep disorders in CKD patients, and show that lack of a refreshing sleep is present even at early stages of the disease and may affect 82.2% of patients without any relationship to comorbidities.

Sleeping disorders in early chronic kidney disease.

Studies in patients on maintenance hemodialysis have disclosed a high prevalence of sleeping disorders, which have been linked to various factors including blood urea levels, creatinine levels, parathyroid hormone levels, anemia, systolic and diastolic blood pressure, quality of life, disease intrusiveness, and comorbidities. In contrast, few studies have been performed in patients with chronic kidney disease (CKD), who represent the target of the present study. A group of 52 CKD patients were enrolled after characterization of their renal function. Comorbidities were evaluated by means of the Charlson Comorbidity Index. Sleep disorders were evaluated by means of the Sleep Disorder Questionnaire (SDQ), a 26-item questionnaire providing a hierarchic classification for relevant insomnia, relevant hypersomnia, subclinical disorders, or absence of sleep complaints. Results indicate that, in the early stages of CKD, at a time the comorbidity index is low, sleep disorders are present in 80.7% of patients. This finding, which needs to be confirmed in a larger cohort of patients, indicates that sleep disorders affect the lives of CKD patients as soon a diagnosis of disease potentially progressing to end-stage renal disease was made.