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Background: Our study aims to provide an overview of existing evidence regarding the image quality of dual-energy CT (DECT) employing reduced contrast media (CM) volumes, in comparison to single-energy CT (SECT) with standard CM loads. The advantages, indications, and possible applications of DECT were investigated from the perspective of providing better patient care, minimizing CM volume and managing CM shortage. Methods: In this systematic review (PRISMA methodology), PubMed and WOS were searched from January 2010 to January 2023 by two independent reviewers. The scan and CM characteristics, radiation dose, and results of quantitative (contrast to noise ratio, CNR, and signal to noise ratio, SNR) and qualitative assessment of image quality were collected. Sixty non-duplicated records eligible for full-text screening were examined. Results: Finally, 22 articles (1818 patients) were included. The average CM reduction with DECT ranged between 43.4 ± 11%. Despite the wide variability in CT scan protocols, no differences were found in radiation doses between DECT and SECT. Conclusions: DECT scanners allow the employment of lower CM volumes with equal or better image quality evaluated by quantitative and qualitative analyses and similar dose radiation compared to SECT. Using image reconstructions at low monochromatic energy levels, DECT increases iodine conspicuity and attenuation contributing to CM containment measures. [ABSTRACT FROM AUTHOR]

Introduction: The combination therapy of platinum and pembrolizumab looks like a promising treatment in advanced non-small-cell lung cancer. However, both platinum-based chemotherapy and pembrolizumab can lead to AKI. AKI can occur due to acute tubular necrosis or interstitial nephritis. It is essential to identify the drug responsible for renal damage. For this purpose, we used new immunohistochemistry markers (p53 and anti-PD1 analysis). Case Description: A 77-year-old female patient with advanced non-small-cell lung cancer received the PD-1 inhibitor pembrolizumab and platinum-based chemotherapy carboplatin. The patient, after 60 days, experienced AKI. A kidney biopsy was performed, and two new immunohistochemical techniques for p53 (experimental markers of ATN from platinum) and anti-PDL1 (experimental markers of PD-1 inhibitors nephritis) were employed. Renal biopsies revealed severe tubular damage. No infiltration was detected, and the immunohistochemical assessment of PDL-1 was negative. The expression of p53 was positive. The renal biopsy suggested platinum-induced acute tubular necrosis. After discontinuing steroids and reducing carboplatin, the patient continued with pembrolizumab, and their renal function returned to normal within two months. Discussion: Combining checkpoint inhibitors and platinum-based therapies may result in AKI. The standard method of examining kidney tissue may not provide sufficient information about the effects of these drugs on the kidneys. To address this issue, we recommend incorporating an assessment of the analysis of the expression of PDL1 and p53. This personalized approach will help identify the best treatment option for the patient while ensuring the best possible cancer treatment plan. [ABSTRACT FROM AUTHOR]

Background The main purpose of our study was to evaluate the ability of renal functional reserve (RFR) to stratify the risk of acute kidney injury (AKI) occurrence within 100 days of hematopoietic stem cell transplantation (HSCT) and to predict any functional recovery or the onset of chronic kidney disease. A secondary aim was to identify the clinical/laboratory risk factors for the occurrence of AKI. Methods The study design is prospective observational. We enrolled 48 patients with normal basal glomerular filtration rate (bGFR) who underwent allogenic HSCT. A multiparameter assessment and the Renal Functional Reserve Test (RFR-T) using an oral protein load stress test were performed 15 days before the HSCT. Results Different RFRs corresponded to the same bGFR values. Of 48 patients, 29 (60%) developed AKI. Comparing the AKI group with the group that did not develop AKI, no statistically significant difference emerged in any characteristic related to demographic, clinical or multiparameter assessment variables except for the estimated GFR (eGFR). eGFR ≤100 mL/min/1.73 m2 was significantly related to the risk of developing AKI (Fisher's exact test, P  = .001). Moreover, RFR-T was lower in AKI+ patients vs AKI– patients, but did not allow statistical significance (28% vs 40%). In AKI patients, RFR >20% was associated with complete functional recovery (one-sided Fisher's exact test, P  = .041). The risk of failure to recover increases significantly when RFR ≤20% (odds ratio = 5.50, 95% confidence interval = 1.06–28.4). Conclusion RFR identifies subclinical functional deterioration conditions essential for post-AKI recovery. In our cohort of patients with no kidney disease (NKD), the degree of pre-HSCT eGFR is associated with AKI risk, and a reduction in pre-HSCT RFR above a threshold of 20% is related to complete renal functional recovery post-AKI. Identifying eGFR first and RFR second could help select patients who might benefit from changes in transplant management or early nephrological assessment. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly spread all over the globe from China. Pleural involvement is not common; around 5–10% of patients can develop pleural effusion and little is known about the involvement of pleural structures in this new infection. A 61-year-old male kidney transplant patient with a history of multiple biopsy-confirmed acute rejections and chronic allograft rejection was admitted to our COVID-19 Unit with dry cough, exertional dyspnea, oliguria, and abdominal distension. Lung ultrasound imaging, chest X-ray, and CT scan showed left pleural effusion and atelectasis of the neighboring lung parenchyma. RT-PCR was positive for SARS-CoV-2 in the pleural fluid and cytology showed mesothelial cells with large and multiple nuclei, consistent with a cytopathic effect of the virus. This is one of few reports describing detection of SARS-CoV-2 in the pleural fluid and to the best of our knowledge, is the first to document the simultaneous presence of a direct cytopathic effect of the virus on mesothelial cells in a kidney transplant patient with COVID-19 pneumonia. The pleura proved to be a site of viral replication where signs of a direct pathological effect of the virus on cells can be observed, as we report here. RT-PCR for SARS-CoV-2 should be part of routine examination of pleural effusion even in patients with mild respiratory symptoms or with comorbidities that seem to explain the cause of effusion. [ABSTRACT FROM AUTHOR]

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected. [ABSTRACT FROM AUTHOR]

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected. [ABSTRACT FROM AUTHOR]