Immunogenicity of COVID-19 vaccination in kidney transplant recipients

Context: Kidney transplant recipients (KTRs) represent a high-risk population but were grossly underrepresented in COVID-19 vaccination trials. Aims: The aim was to study the immunogenicity of two COVID-19 vaccines (Covaxin and Covishield) among KTRs. Subjects and Methods: We conducted a prospective observational study among KTRs who consented to receive two doses of the COVID-19 vaccine – either Covaxin or Covishield. Patients who underwent kidney transplant during the previous 6 months or had received antirejection therapy during the previous 1 month were excluded from the study. Antibody titers to the spike protein of COVID-19 were measured at baseline and at 4 weeks after the second dose of the vaccine. Statistical Analysis: A univariate analysis was performed in the subgroup of patients who were seronegative at baseline, to identify factors that were associated with seroconversion. The Chi-square test or the Fisher's exact test was used to compare categorical variables, and the Mann–Whitney U-test was used to compare continuous variables. P 250 U/mL. Conclusions: Among KTRs who were seronegative at baseline, a seroconversion rate of 34.5% was demonstrated after two doses of Covaxin or Covishield

Complementary and Alternative Medicine Use and Glomerular Disease: A Contemporary Case Series

Rationale & Objective: Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India. Heavy metals are known ingredients in some of these formulations. We studied the spectrum of glomerular diseases in patients using CAM. Study Design: Case series. Setting & Participants: Patients with proteinuria or unexplained acute kidney injury, who underwent a kidney biopsy between May 2021 and September 2022, and who provided a history of recent CAM intake were included in the study. For patients enrolled prospectively, blood and urine samples were analyzed using mass spectrometry for the presence of mercury, lead, arsenic and cadmium. The CAM formulation, when available, was analyzed using inductively coupled plasma-optical emission spectroscopy. Results: Twenty-eight patients were enrolled in the study, with a median duration of CAM intake of 4 months (interquartile range, 2-6 months). Heavy metal screening was performed in 17 patients, of whom 15 had elevated urine mercury levels, 10 had elevated blood mercury levels, and 1 had elevated blood and urine arsenic levels. Of the 6 CAM formulations that were analyzed, all had high levels of mercury. Kidney biopsy findings were membranous nephropathy (n = 19), minimal change disease (n = 8), and mesangial proliferative glomerulonephritis (n = 1). Of the 19 patients with membranous nephropathy, 14 were associated with neural epidermal growth factor-like protein 1 (NELL-1). With conservative management alone, 17 patients achieved complete remission. Limitations: Not all patients underwent blood and urine mercury testing, and only 6 patients provided the CAM samples for analysis. Furthermore, occupational and residential exposure to mercury could not be excluded. Conclusions: The most common kidney pathology noted in our study was membranous nephropathy, which was predominantly associated with neural epidermal growth factor-like protein 1. A significant proportion of the patients recovered completely after withdrawal of the offending agent and initiation of renin-angiotensin system blockade. Plain Language Summary: Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India, and heavy metals are known ingredients in some of these formulations. We describe the clinical spectrum of kidney disease, among patients who had recently ingested CAM. All patients underwent a kidney biopsy, and the most common finding was an entity called “NELL-1-associated membranous nephropathy,” which is known to be associated with heavy metal toxicity and CAM intake. Of 17 patients screened for such heavy metals, 15 had greater-than-permissible levels of mercury. Furthermore, 6 patients provided the CAM formulations that they had consumed for analysis: all contained high levels of mercury. Most such patients recovered following withdrawal of the offending CAM agent