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Background The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy. Methods The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression. Results Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08–1.17], liver disease (OR 2.27, 95% CI 1.21–4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07–1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92–0.99) were protective. Conclusions This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.

Background and Aims An increasing number of patients are returning to dialysis after kidney allograft failure (KAF). These patients are at higher risk of complications and mortality compared with incident ESKD patients.. In the pediatric population these data are missing and outcomes have never been investigated before in a nationally representative sample. The aim of this study was to describe the characteristics and hard outcomes of children entering dialysis after KAF in a large population of pediatric dialysis patients. Method We retrospectively reviewed the files of patients receiving chronic dialysis at Results After KAF, 45 (35.7 %) patients were treated with PD and 81 (64,3%) with HD. Prior to kidney transplantation (Ktx), 74 (58.7%) were on PD, 45 (35.7%) on HD, and 7 on conservative care (5.5%). Compared with PD patients, those on HD were older (median age of 14.8 years [IQR 11.4-17.5] vs. 10.8 [IQR 2-6.5] vs.; p=0.002), had a longer transplant vintage ([55.2 months [13.2-100.3]) vs. 33 [5.1-82.2], and reentered dialysis in more recent calendar years (2013 [2007-2017] vs. 2004 [2001-2009]). Significant predictors for being treated with PD after KAF were a younger age at dialysis start (OR 0.83 per year increase [95%CI 0.72-0.94]) and a history of PD use before Ktx (OR 12.74 [2.2-74.6]). Patients returning to dialysis in more recent eras (OR 0.87 per year increase [0.81-0.94]) and those who were treated with more than one dialysis modality before Ktx (OR 0.15 for being treated with PD [0.04-0.63]) were more likely to be initiated on HD. Over the observation period, 6 PD (13.6%) and 3 HD (4.2%) patients died. After adjustment for several covariates, patients on PD exhibited an increased risk for mortality compared with HD (HR 4.65 [1.12-19.30], while the difference for modality failure and access to renal transplantation did not reach statistical significance (Fig.1) Conclusion Patients returning to dialysis after KAF in more recent years are more likely to be initiated on HD rather than PD. According to our registry data, the use of PD is associated with a lower survival among patients initiating dialysis after KAF. Fig.1 Cumulative incidences for the competing events, death, transplant and other techniques (solid line: PD, dash line: HD)

Corticosteroid-related toxicity in children with steroid-sensitive nephrotic syndrome is primarily related to the cumulative dose of prednisone. To optimize treatment of relapses, we conducted the PROPINE study, a multicentric, open-label, randomized, superiority trial. Seventy-eight relapsing children aged 3-17 years who had not received steroid-sparing medications during the previous 12 months were randomized to receive, from day five after remission, either 18 doses of 40 mg/m2 of prednisone on alternate days (short arm), or the same cumulative dose tapered over double the time (long arm). Patients were monitored with an ad-hoc smartphone application, allowing daily reporting. The primary outcome was the six-month relapse rate at which time, 23/40 and 16/38 patients had relapsed in the long and short arms, respectively (no significant difference). Additionally, 40/78 patients were also enrolled in a secondary crossover study and were allocated to the opposite arm. Altogether, at six months, the relapse rate was 32/40 and 28/40 in the long and short arms, respectively (no significant difference). A post-hoc analysis excluding 30 patients treated with low-dose prednisone maintenance therapy failed to show significant differences between the two arms. No differences in adverse events, blood pressure and weight gain were observed. Thus, our data do not support the prescription of prolonged tapering schedules for relapses of steroid-sensitive nephrotic syndrome in children.

Evidence regarding hospital-based acute kidney injury (AKI) reveals a continuous increase in incidence over the years, at least in intensive care units (ICU). Fewer reports are available for non critically-ill patients admitted to general or specialist wards other than ICU (non-ICU). The consequence of greater incidence is an increase in therapies such as dialysis; but how the health care organization deals with this problem is not clearly known. Here we quantified the incidence of dialysis-requiring AKI (AKI-D) among patients admitted to a University Hospital which serves a population of 354,000 inhabitants. Between 2007 and 2012, the incidence of AKI-D increased from 209 to 410 per million population (pmp)/year; age of patients and cardiovascular comorbid pathologies also increased. AKI-D was more frequent in non-ICU and 32 % of patients were admitted to ICU. Considering the site of treatment of non-ICU patients, in 2007 the ratio of patients admitted to non-ICU wards apart from Nephrology to those admitted to Nephrology was 1:1, but in 2012 the ratio increased to 2.4:1 (p