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Psoriasis vulgaris is a complex immune-mediated disorder that manifests as a chronic skin disorder, characterized by well-circumscribed inflammatory, erythematous plaques. In this case report, we present a patient with generalized pustular psoriasis (GPP) who presented to the nephrology department with rapidly progressive decline in renal function. The diagnosis of GPP was made a month ago, secondary to a coagulase-negative staphylococcal superinfection. Intrinsically, this introduced a diagnostic challenge as the presumed diagnosis of immunoglobulin A (IgA) nephropathy had to be distinguished from IgA-dominant infectionrelated glomerulonephritis. We further discuss the current evidence and immunohistological profiles of IgA nephropathy in psoriasis and detail the evolution of renal function of our patient over 25 months after he presented to our department.

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Background:Intravenous iron is commonly prescribed in chronic kidney disease (CKD) patients. Iron sucrose (IS) and ferric carboxymaltose (FCM) are 2 frequently used formulations. Experimental data showed that this 2 intravenous iron preparations have different potential to induce oxidative stress and by that endothelial dysfunction. Still, direct comparisons in clinical settings are rather scarce.Study Question:Are there any acute changes in endothelial function after single intravenous iron infusions of IS and FCM in nondialysis CKD patients?Study Design:This was a prospective, crossover study in which 31 patients with CKD stages 3–5 (80% stages 3 and 4, 81% female, 55% older than 60 years, 23% diabetes mellitus, and 94% arterial hypertension) who required intravenous iron as part of their routine medical care were enrolled.Measures and Outcomes:The effect of flow-mediated vasodilatation infusions containing 250-mL 10% glucose, 500-mg FCM, and 200-mg IS, both in 250-mL 0.9% saline solution, was compared. The infusions were administered over 30 minutes, 72 hours apart, in the mentioned order. Ultrasound measurement of the brachial artery flow-mediated vasodilation (FMD) performed 15 minutes before and after each infusion was used to assess endothelial function. The outcome was the post/preinfusion difference (Δ) in FMD.Results:The baseline FMD was similar before each study intervention. The arterial reactivity significantly decreased only after IS infusion [ΔFMD −2.3 (−5.65 to −0.33) vs. 1.0 (−1.49 to 1.80) after glucose, P = 0.01], but not after FCM [ΔFMD −0.8 (−2.50 to 0.65), P = 0.27 vs. glucose]. Moreover, the arterial reactivity was higher after IS as compared to FCM.Conclusions:Endothelial dysfunction seems to be acutely induced by a single dose of intravenous IS, but not by FCM, in nondialysis CKD patients.

Conclusions: Hypovitaminosis D is significantly higher amongst patients with CKD compared with age-and sex-matched control participants in our centre and the predictors were eGFR (strongest), LVMI and uACR. Larger studies are required to determine the role of vitamin D on cardiovascular (CV) outcomes in these patients.

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