New Onset Biopsy-Proven Nephropathies after COVID Vaccination

INTRODUCTION

To date, almost 7 billion doses of the different types of vaccine against SARS-CoV-2 have been administered worldwide. Although the severity of new cases of SARS-CoV-2 has progressively decreased, and the pressure on national health systems has declined, the development of de novo glomerular injuries has been suggested.

METHODS

This study aimed to examine the patients who were hospitalized in our Unit between April and November 2021 and underwent renal biopsy for new-onset urinary abnormalities (UA) and/or renal impairment within 3 months of SARS-CoV-2 vaccination.

RESULTS

We identified 17 patients who developed UA and/or renal insufficiency within 3 months of vaccination. Minimal change disease was the most common disease in our cohort (5 patients, 29.4%) followed by acute tubulointerstitial nephritis (TIN; 3 patients, 17.6%), membranous nephropathy (3 patients, 17.6%), and rapidly progressive IgA nephropathy (2 patients, 11.8%). The other 4 patients had a diagnosis of membranoproliferative glomerulonephritis (1 patient), systemic lupus erythematosus (1 patient), ANCA-associated vasculitis (1 patient), and tip-variant focal segmental glomerulosclerosis (1 patient), respectively. Eight out of the 17 patients (47.1%) developed acute kidney injury. Two patients with acute TIN had to start hemodialysis that was discontinued after 1 and 2 months, respectively, due to the recovery of renal function. All patients underwent treatment with corticosteroids and/or immunosuppressants.

DISCUSSION

Although it is not possible to conclusively determine whether there is a causal relationship between SARS-CoV-2 vaccination and new-onset nephropathies, based on the appearance of UA and/or renal insufficiency shortly after vaccination, we hypothesize that the immune response to the COVID-19 vaccine may be a trigger of nephropathies. Therefore, our results highlight the need for pharmacovigilance. However, this report should not lead to vaccine hesitation during this pandemic as the benefits of vaccination strongly outweigh the potential risks.

Incidence trends and long-term outcomes of myocardial infarction in young adults: Does gender matter?

AIMS

Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant.

METHODS AND RESULTS

Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%).

CONCLUSION

Among young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.

294 Incidence trends and long-term outcomes of juvenile myocardial infarction: does gender matter?

Aims

Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI), along with the potential impact of gender on incidence and prognosis in such subset are scant and mostly including USA populations. Thus, there is a paucity of data about European patients suffering from a juvenile MI. Purpose. The purpose of the current study was to investigate temporal trends, survival, MI recurrence, and sex differences among subjects who experienced their first MI at young age in the Piedmont region (Italy) between 2007 and 2018.

Methods and results

Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences (ICD-9-CM codes: ‘410’, ‘411’, and their subcodes). Patients were considered young if the first MI occurred before or at 47 years of age. Incidence of first Juvenile MI event and subsequent overall survival among patients who survived to hospital discharge were defined as primary outcomes of interest. Subgroup analysis were performed according to sex category, comorbidities and clinical intervention (obtained from the HDRs records). Incidence of MI recurrence among patients who survived to hospital discharge was defined as secondary outcome of interest. Lastly, we evaluated whether experiencing a MI recurrence was associated with a lower overall survival at follow-up. Out of 114 816 hospitalizations due to MI, 4482 occurred in people aged ≤47, with median age 44 years old. At baseline, men had more hypertension (13% vs. 9.4%, P < 0.006) and dyslipidaemia (18.2% vs. 9.9%, P < 0.001), while women more cardiac arrest at presentation (2.9% vs. 1.7%, P = 0.03), cardiogenic shock (2.1% vs. 1.3%, P = 0.06), and less likely to undergone PCI (53.9% vs. 74.3%, P < 0.001). More women (n = 14; 1.9%) than men (n = 33; 0.9%) died while in-hospital, adjusted OR: 2.12; 1.13–3.99. After a median follow-up was 7.2 years (IQR: 4.2–9.9), the survival rate after the first MI was 94.8%, without differences between men and women (HR: 1.05; 0.69–1.60). Age at first MI, year of hospitalization, hospitalization length, chronic kidney disease, cardiogenic shock, third degree atrio-ventricular block, and PCI were found independent predictors of long term survival. 348 (7.8%) experienced at least one MI recurrence and it was more common in men than women (adjusted HR: 0.72; 0.52–0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR: 3.05; 1.9–4.80, all 95% CI).

Conclusions

In young patients with a MI, women had more in-hospital mortality compared to men, but among patients who survived to hospital discharge, overall long-term prognosis did not differ. MI recurrences were more common in men and were associated with lower long-term survival rate.

[I thought it was right... Late diagnosis of accidental lead misplacement in the left ventricle across patent foramen ovale]

Accidental lead misplacement in the left ventricle is a rare complication, which should be diagnosed early and treated with lead removal. In case of late diagnosis, chronic anticoagulant therapy or, if the patient needs cardiac surgery for other reasons, surgical lead removal are recommended. In the present case, lead misplacement occurred at the time of a traditional pacemaker implantation due to bradycardia.