The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.

ACL without APS before kidney transplantation is an independent risk factor of eGFR decline within the first year post-transplant without over-incidence of TEs. Specific immunosuppressive therapy including mammalian target of rapamycin inhibitors should be discussed in the future.

We herein present a case of bilateral serous retinal detachment (SRD) as a presenting sign of nephrotic syndrome (NS). A 48-year-old man complained of decreased vision related to bilateral SRD. Laboratory tests revealed NS (serum albumin, 17 g/L: proteinuria, 15.40 g over 24 hours). Following treatment for edema with a diuretic, the bilateral SRD resolved completely, with a full recovery of the patient's vision. A kidney biopsy disclosed glomerular and vascular amyloid deposits; the amyloid stained strongly with anti-λ antiserum. Therefore, a diagnosis of AL amyloidosis was made. The sudden appearance of SRD should raise suspicion of a diagnosis of NS. Prompt recognition of this symptom is important for early treatment and restoration of the visual function.

BackgroundPemetrexed, a multitargeted antifolate cytotoxic agent, is currently used primarily in combination with cisplatin for metastatic non-small cell lung cancer and for malignant mesothelioma. Acute renal toxicity of pemetrexed has been recently described with polychemotherapy, in which the individual responsibility of each drug is difficult to establish. Only one recent report documents renal involvement in long-term exposed patients.Case presentationWe report on a case of rapidly progressive nephropathy leading to the cessation of platinum salts and the secondary interruption of pemetrexed and bevacizumab. Acute tubular necrosis shown on the renal biopsy could potentially be due to pemetrexed. Persistent severe renal failure after the resumption of all drugs led to new treatment lines with gemcitabine (while the glomerular filtration rate was below 30 ml/min/1.73m2), then followed by Taxol.ConclusionsThe optimal strategy with regard to renal complications in cancer patients is not clear. Acute or chronic loss in renal function generally leads to a new treatment line, possibly impairing the overall success of the treatment. The use of chemotherapy in patients with a glomerular filtration rate below 30 ml/min/1.73m2 is usually associated with an increased risk of side effects when not contraindicated by renal elimination of the drug.

LETTERS TO THE EDITORTO THE EDITOR: We read with great interest the excellent review by Dore 1 on the prevention of glucocorticoid-induced osteoporosis. As indicated by the author, bone loss is one of the most serious complications of corticosteroid therapy, causing significant costs, morbidity, and mortality related to vertebral and hip fractures. Therefore, prevention of bone loss is mandatory, and several drugs are available.However, the author does not mention strontium ranelate in the armamentarium for this preventive treatment. Strontium ranelate is an orally administered treatment of postmenopausal osteoporosis, reducing the risk of vertebral and hip fractures, and its efficacy has been demonstrated in clinical and histologic studies. 2,3 It has a particular mode of action, since it simultaneously inhibits bone resorption and stimulates bone formation. 2,3 Only minor adverse effects have been reported, including gastrointestinal signs such as nausea and diarrhea (only during the first 3 months), headache, and skin lesions. Strontium ranelate is currently licensed for the treatment of postmenopausal osteoporosis, but it appears to be an effective solution for diverse fracture risks, including the treatment of glucocorticoid-induced osteoporosis.In a 2-year observational, controlled study that included 107 patients with glucocorticoid-induced osteoporosis treated with strontium ranelate or risedronate, there was a significantly higher increase in lumbar spine and total hip bone mineral density and a stronger reduction in back pain in the group of patients treated with strontium ranelate than in the group of patients under risedronate therapy, but the number of patients with no new fractures was similar in both treatment groups. 4 In an animal model, strontium ranelate was significantly superior to alendronate in the prevention of glucocorticoid-induced osteopenia according to bone mineral density and histomorphometric analysis. 5

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