Novel Coronavirus disease (COVID-19) is a newly discovered contagious disease that has affected many countries around the world. Although diffuse alveolar damage and acute respiratory failure are the main features, involvement of other organs is recognized and needs to be explored. Information on kidney disease in patients with COVID-19 is limited, with many studies showing that acute kidney injury is an uncommon disorder in COVID-19. Despite this low prevalence, it can lead to potentially significant morbidity and mortality in these patients. Thus the authors consider the development of acute kidney injury in patients with COVID-19 an important issue, worthy of clinical attention, and they present this point in the current review.

Introduction: Tuberous sclerosis complex is an autosomal dominant neurocutaneous disorder which is characterized by multisystem involvement, including the kidney. Since renal disease is one of the causes of morbidity and mortality, close management is essential. Subjects and Methods: In this retrospective observational,single-center study, authors analyse patients with a definite diagnosis of tuberous sclerosis complex who attended Pediatric Nephrology consultation between 1998 and 2019. Results: 20 patients were included. The median age at the time of the diagnosis was 3 years, mostly after seizures and the median age of the first Pediatric Nephrology consultation was 9 years. Seventeen patients had renal disease, the majority with angiomyolipomas and a smaller number with cysts. None had hypertension or history of acute kidney failure. Systemic mTOR inhibitors were used in three patients. Discussion: The present results were similar to those found in the literature regarding presentation features and kidney disease. The authors emphasized the importance of early diagnosis of renal involvement in order to reduce renal morbidity and mortality (especially when these patients reach adulthood) and highlighted the need for early guidance for pediatric nephrology consultation.

Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that has been associated with delayed pulmonary toxicity. In patients receiving RTX, hypersensitivity pneumonitis, although rare, should be considered in the appropriate clinical and radiographic setting. The authors present a case of hypersensitivity pneumonitis associated with a single dose of RTX treatment in a kidney transplanted patient with acute antibody-mediated rejection.

RESUMO O índice de gravidez de mulheres em diálise permanece ainda muito baixo quando comparado ao da população restante. Contudo, nos últimos anos, o sucesso dessas gestações tem aumentado. Entre os principais cuidados que se deve ter com as grávidas em diálise estão a manutenção de níveis baixos de ureia pré-diálise, a adequação do perfil tensional, o controle da anemia e os cuidados para evitar infecções, deficit nutricionais, alterações do metabolismo fosfo-cálcio e flutuações eletrolíticas. O monitoramento rigoroso do crescimento e desenvolvimento fetal é também necessário. Gravidezes em diálise estão associadas à maior probabilidade de complicações maternas e fetais, por isso é de extrema importância uma abordagem multidisciplinar entre nefrologistas, obstetras e pediatras. O objetivo principal do presente trabalho consiste na revisão da evidência literária disponível sobre a gravidez em diálise, sobre os princípios básicos da fisiopatologia da grávida e de suas particularidades na doença renal. Serão abordadas as opções de tratamento disponíveis, as vantagens e os riscos, antevendo possíveis desafios futuros. No final, será apresentado um caso clínico ilustrativo da temática.

ABSTRACT The pregnancy rate of women on dialysis is still very low when compared to that of the remaining population. However, recent years have seen an increase in the success rates of these pregnancies. Among the main precautions that must be taken with pregnant women on dialysis are the maintenance of low levels of pre-dialysis urea, the adequacy of the tension profile, the control of anemia and care to avoid infections, nutritional deficits, changes in phosphorus-calcium metabolism and electrolytic fluctuations. It is also necessary to strictly monitor fetal growth and development. Pregnant women on dialysis have a higher probability of maternal and fetal complications; thus the importance of a multidisciplinary approach among nephrologists, obstetricians and pediatricians. The main objective of this study was to review the literature evidence available on pregnancy on dialysis, on the basic principles of the pathophysiology of pregnant women and their particularities in kidney disease. We will address available treatment options, benefits and risks, anticipating possible future challenges. At the end, we will present a clinical case to illustrate the topic.

Atheroembolic renal disease is a multisystem clinical entity of unknown incidence. It is often associated with severe atherosclerotic disease and its etiology can be spontaneous or iatrogenic. Its pathophysiology is based on renal dysfunction secondary to embolization of cholesterol crystals, followed by occlusive phenomena affecting the renal vasculature. The present report describes the case of a patient with several cardiovascular risk factors, with a recent introduction of rivaroxaban. The clinical course presented was suggestive of renal atheroembolic disease, and the histological evaluation corroborated this diagnosis.

Introduction: ABO incompatibility was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long-term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Methods: The authors present a single-center retrospective observational study in a unit with approximately 370 living donor kidney transplants registered. This study includes the analysis of 12 patients who underwent ABOi living donor kidney transplantation between November 2014 and July 2019. Desensitization protocol consisted of intravenous Rituximab 375mg/m2 single dose administration 2 weeks pretransplant. Tacrolimus and Mycophenolate Mofetil were started before transplantation one week and 48 hours respectively. Plasmapheresis was performed to remove anti-A or B antibodies until their titers were <1:8 during the first post-operative week and <1:16 at the second. All kidney recipients of both ABOi grafts received Basiliximab (20mg on days 0 and 4) as antibody induction therapy. Maintenance immunosuppression consisted of Tacrolimus, Mycophenolate Mofetil and corticosteroid. Results: A total of 12 patients were included in the study, 75% male; 43 years (IQR 31-50). The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (25%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion: ABOi kidney transplantation has become a routine procedure. With this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. The immunosuppressive protocol of this unit can be considered safe.

Sarcoidosis is a rare multisystem disease that is characterized by the formation of inflammatory granulomatous processes. The lung is the most frequently affected organ, but kidney injury can also occur. It is a disease with a highly variable course and prognosis and non-consensual treatment. This report describes the successful case of a patient with sarcoidosis presenting with pulmonary, cutaneous and renal injury, who presented with adequate diagnostic timing and optimal therapy response.