Abstract Background BK polyomavirus (BKPyV) nephropathy is an important cause of graft dysfunction and loss after kidney transplant. Treatment options are limited and predominately involve immunosuppression reduction with a limited role for anti-viral medications. There have been some reports of BKPyV-DNAemia and its association with bladder cancer. Methods We examined the incidence and impact of BKPyV in 1372 first-time kidney transplant recipients from 2011 to 2022, using prospectively collected data from the National Renal Transplant Registry and the National Virus Reference Laboratory. We assessed risk factors, graft survival, and development of post-transplant bladder cancer. Recipients underwent regular viral load monitoring with BKPyV-DNAemia defined as >1000 copies per millilitre (CPM). Results BKPyV-DNAemia was detected in 22.2% of recipients. Graft survival was comparable between groups; five-year survival was 91% in the BKPyV-DNAemia-positive group versus 88% in the BKPyV-DNAemia-negative group. Post-transplant bladder cancer occurred in .87% (n = 12) of recipients. However, bladder cancer occurred in 2.6% (n = 8) of BKPyV-DNAemia-positive compared to 0.37% (n = 4) of BKPyV-DNAemia-negative recipients. Multivariate analysis revealed a significantly increased risk of bladder cancer in the BKPyV-DNAemia group (adjusted hazard ratio 4.95, P = .008), furthermore we noticed a marked increase in hazard ratio as levels increased from 1000 CPM to 10 000 CPM. In BKPyV-DNAemia patients, median time to cancer diagnosis was 72 months post-transplant, with median survival of 25 months after diagnosis. Conclusions This association between BKPyV-DNAemia and post-transplant bladder cancer suggests the need for close surveillance for signs of bladder cancer in these patients.
Abstract Background Pregnancy in women with type 1 diabetes (T1D) complicated by overt diabetic nephropathy (DN) remains a major clinical challenge, with limited data on maternal-foetal outcomes. This study describes the clinical course and outcomes of pregnancies in women with overt DN followed in a dedicated nephrology-obstetric care setting. Methods We conducted a retrospective analysis including 15 pregnancies, 13 of which had complete baseline and delivery data, in women with T1D and overt DN followed at Policlinico Umberto I (Rome-Italy), between 2010 and 2022. Maternal characteristics, renal and obstetric complications, and perinatal outcomes were analysed from baseline to six months postpartum. Results Thirteen pregnancies were analysed. Median baseline estimated glomerular filtration rate (eGFR) was 67.6 (42.9-95.8) ml/min/1.73m2, median proteinuria 0.8 (0.5-1.6) g/day; 69% had chronic hypertension and 84% diabetic retinopathy. Proteinuria increased during pregnancy in 9/13 cases. Two patients developed acute kidney injury, one of whom required haemodialysis during pregnancy and remained dialysis-dependent thereafter. Superimposed preeclampsia occurred in five cases and was associated with lower baseline eGFR. Preterm delivery was common; all the patients delivered by caesarean section. A decline ≥10 mL/min/1.73 m2 in eGFR or dialysis initiation was observed in 4 patients at 6-month follow-up; in the remaining patients, no significant changes were observed, although the follow-up was limited to 6 months. Conclusions Pregnancy in women with overt DN continues to entail substantial maternal and foetal risk. Early nephrology referral, strict metabolic and blood pressure control, and systematic preconception counselling are crucial to optimising outcomes and preventing irreversible renal decline.
Abstract Calciphylaxis is a life-threatening and rare disease, also known as calcific uremic arteriolopathy (CUA). Skin biopsy is the gold standard for diagnosis. However, it is an invasive procedure and might aggravate the ulcer. Therefore, additional precise diagnostic approaches are needed. In this case report, a patient with end-stage renal disease receiving peritoneal dialysis presented with skin ulceration and necrosis on the left leg. Considering the risk of aggravating the existing ulcer, we performed an ultrasound-guided core-needle biopsy. Histopathological examination confirmed calcification of small- and medium-sized vessels in the dermis and subcutaneous tissue, supporting the diagnosis of calciphylaxis. The patient subsequently received comprehensive treatment, including sodium thiosulfate therapy, wound care, correction of chronic kidney disease–mineral and bone disorder, and adjustment of dialysis therapy. With comprehensive and timely treatment, the patient's skin lesions gradually improved and showed progressive healing. This case suggests that ultrasound-guided core-needle biopsy may represent a feasible diagnostic option for calciphylaxis, providing histopathological confirmation.
