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.

Renal involvement in mantle cell lymphoma (MCL) is rare. We present the case of a man followed for MCL presented with acute kidney injury and positive antineutrophil cytoplasmic antibody (ANCA) type anti proteinase 3 (PR3). He was treated as for a rapidly progressing glomerulonephritis with cyclophosphamide and methylprednisolone followed by oral prednisone. Renal biopsy revealed diffuse endocapillary proliferation and segmental extracapillary proliferation in four glomeruli. Immunohistochemistry confirmed the renal invasion of lymphomatous cells. He started improving his renal function shortly after starting treatment. The coexistence of renal MCL infiltration, extracapillary proliferation and ANCA positive is exceptional.

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Background and Aims Anti-Glomerular basement membrane disease « anti-GBM » is a rare autoimmune disease. It most often results in a rapidly progressive glomerulonephritis syndrome associated with intra-alveolar hemorrhage. The diagnostic confirmation is histological, by the demonstration of linear deposits of immunoglobulins (IgG) along the glomerular basement membrane. The aim of our study was to describe its epidemiological, clinical, biological, immunological, histological, and evolutionary characteristics and to identify the different prognostic factors for predicting patient survival and renal survival. Method It was a retrospective, descriptive and analytical study including patients over 16 years old with anti-GBM disease proved by kidney biopsy and followed up over a period of 32 years (January 1985 to July 2017), in Internal Medicine Department of Charles Nicolle Hospital of Tunis. Results We collected 32 patients with a sex ratio H/F = 1.13. The mean age at diagnosis was 42 years old with extremes of 18 to 81 years old. The most frequent extra-renal manifestations were pulmonary (53%), neurological (12.5%) and ocular (6%) manifestations. Hematuria associated with proteinuria was constantly found. The latter was nephritic in 31% of patients. All patients had renal insufficiency on admission, oligo-anuric in 60% of cases. The use of extra-renal treatment at admission was necessary in 75% of patients. On the immunological level, the search for anti-MBG antibodies, performed in 20 patients, was positive in 65% of cases. All our patients had undergone a renal biopsy puncture with direct immunofluorescence study. Diffuse extra-capillary glomerulonephritis was observed in 93% of patients. Corticotherapy was initiated in 27 cases, associated with plasma exchange in 21 cases and cyclophosphamide in 17 cases. Nine of our patients died in the first year. Renal outcome was marked by partial remission in 2 cases and end-stage renal failure in 19 cases. In univariate analysis, an age greater than 60 years and the occurrence of respiratory distress were predictors of death. Oligo-anuria and need dialysis on admission were predictive factors for progression to end-stage renal failure. Conclusion Anti-GBM disease is a serious illness. Current therapeutic modalities have significantly improved patient survival. These must be intensive and rapid in order to hope for a favorable renal evolution whose prognosis remains reserved.

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Conclusions: Not only is this an unusual case of polyomavirus BK virus nephropathy in the native kidney with a strikingly high BK load of 10 8 , but it is also the first reported association of BK virus nephropathy with thrombotic microangiopathy in a patient with no prior transplantation history and no active immunosuppression regimen. This case highlights the importance of considering BK virus nephropathy in the differential diagnosis of kidney dysfunction not only among transplant recipient but in all immunocompromised hosts including B-cell depleting regimens. If left untreated, we believe that high BK viral loads can become clinically symptomatic and cause endothelial dysfunction resulting in renal TMA as we described here for the first time. More studies are needed to define the best therapeutic approach to BK virus nephropathy in non-transplant patients.

Glomerulonephritis (GN) is one of the major causes of chronic kidney disease (CKD) worldwide. It remains the leading cause of End Stage Kidney Disease (ESRD) in many developing countries including Nigeria with varying clinical course and histologic pattern. The clinical outcome and the degree of renal impairment observed in patients with glomerulonephritides is dependent on the type and extent of the histological lesion identified in the glomerulus and tubulointerstitium. Renal biopsy remains an important diagnostic tool in patients with glomerulonephritis with varying indications. This study is unique because the histologic features observed in the glomerulus and tubulo-interstitium were graded, scored and correlated with clinical as well as biochemical features. This will add to the body of knowledge on glomerulonephritides in this environment. The objectives of the study was to determine the grading and severity of histologic features observed in the glomerulus and tubulo-interstitium and to determine the relationship (if any) between clinical, biochemical and histologic features in adults with GN at OAUTHC, Ile-Ife. Methods: The study was a cross sectional hospital based study of seventy ( 70) consecutive adult patients with features of glomerulonephritis who presented at the nephrology and other clinics of OAUTHC Ile-Ife. Renal function was assessed and renal biopsy performed after obtaining written informed consent. The renal tissues obtained were subjected to light microscopy and immunoperoxidase staining with IgA, IgM, IgG and C 3 antibodies and the degree of involvement of glomeruli, tubules, interstitium and vessels were graded from 1 to 5 for the glomeruli and 1 to 3 for the tubulo-interstitium respectively according to severity. Total activity and total chronicity indices were collated and their association/correlation with clinical parameters assessed.Results: A total of seventy patients participated and completed the study. Three (3) patients had inadequate renal tissue for histologic diagnosis hence data analysis was based on the remaining sixty seven (67) patients. Statistically significant correlations were found between the interstitial scores for activity (interstitial oedema, interstitial infiltrate) with serum creatinine and GFR: interstitial oedema with serum creatinine (r¼0.35, p¼0.003) and GFR (r¼-0.38, p¼0.004); interstitial infiltrate with serum creatinine (r¼0.52, p<0.0002) and GFR (r¼-0.70, p¼0.002) and total activity index with serum creatinine (r¼0.60, p¼0.0001) and GFR (r¼ -0.48, p ¼ 0.004). Statistically significant correlations was also seen between total chronicity index and test of renal function: total chronicity index with serum creatinine (r¼0.62, p¼0.001) and GFR (r¼ -0.58, p<0.00001). Conclusions: Both activity and chronicity indices significantly influence renal function. The higher they are the lower the GFR and vice versa, this suggests aggressive management protocol for patients with higher indices. The histologic scoring system would assist in assessing the severity of...

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