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Tolvaptan (TVP) is a selective antagonist of vasopressin receptors, approved for the treatment of hyponatremia in SIADH, congestive heart failure (CHF) and cirrhosis. We retrospectively reviewed all cases where TVP was used in a tertiary hospital (January 2012- January 2017). Our aim was to study the use of TVP in real life practice in patients with portal hypertension (PHT) (past history of non-malignant ascites or variceal bleed).

Kidney biopsy; Renal pathology; Solid organ neoplasm Biòpsia renal; Patologia renal; Neoplàsia d'òrgans sòlids Biopsia renal; Patología renal; Neoplasia de órganos sólidos Background: Currently, following the new advances in cancer treatments and the increasing prevalence of kidney disease in the population, more kidney biopsies are being performed. The aim of our study is to analyze clinical and histological characteristics of patients with active solid organ malignancy who underwent kidney biopsy. This is a multi-center collaborative retrospective study supported by groups GLOSEN/Onconephrology from the Spanish Society of Nephrology. Clinical, demographical and histological data were collected. Results: A total of 148 patients with cancer who underwent a kidney biopsy from 12 hospitals were included. 64.3% men and mean age of 66.9 years old. The indications for biopsy were acute renal injury (67.1%), proteinuria (17.1%), exacerbated chronic kidney disease (8.2%), and chronic kidney disease (7.5%). Most frequent malignances were lung (29.1%) and abdominal (25%), with 49.7% metastatic cancer. As oncospecific treatment, 28% received chemotherapy, 29.3% immunotherapy, 19.3% specific therapies, and 2.1% conservative treatment. At the time of kidney biopsy, median creatinine was of 2.58 mg/dL [1.81–4.1 (IQ 25–75)], median urine protein-to-creatinine ratio of 700 mg/g [256–2463 (IQ 25–75)] and 53.1% presented hematuria. The most frequent renal biopsy diagnoses were: acute interstitial nephritis (39.9%), acute tubular necrosis (8.8%), IgA nephropathy (7.4%) and membranous nephropathy (6.1%). Median follow-up was 15.2 months [5.7–31.4 (IQ 25–75)]. Conclusions: There is a new trend in kidney disease and cancer patients in terms of diagnosis and treatment. Acute interstitial nephritis has established itself as the most common kidney injury in patients with cancer who underwent a kidney biopsy. Renal biopsy is a valuable tool for diagnosis, treatment, and prognosis of solid organ cancer patients with kidney damage. This work was supported by grants from Fondo de Investigación Sanitaria-FEDER, ISCIII, Río Hortega CM20/00111, PI17/00257, PI21/01292, Marató TV3 2020 421/C/2020, Marató TV3 2021 215/C/2021, RD16/0009/0030 (REDINREN), EIN2020-1123381, and RD21/0005/0016 (RICORS 2040).

BACKGROUND AND AIMS Acute kidney injury (AKI) has been described as a frequent complication in patients with COVID-19. The incidence of AKI is estimated to be around 5%–80% depending on the series; however, data characterizing the type of AKI and the evolution of renal function parameters in the medium-long term are still limited. METHOD Based on the initial AKI-COVID Registry, we developed an extended registry where we registered retrospectively new variables that included clinical and demographic characteristics, infection severity parameters and data related to AKI (ethology, KDIGO classification, need of renal replacement therapy, analytic values: baseline creatinine, maximum creatinine during admission, creatinine at discharge or death, creatinine at 1 month after hospitalization and urinary parameters). Recovery of kidney function was defined as difference in at discharge or posthospitalization creatinine RESULTS Our analysis included 196 patients: 74% male, mean age 66 + 13 years; 65% hypertensive, 33% diabetic and 22% chronic kidney disease. According to the KDIGO classification: 66% AKI KDIGO3, 17% KDIGO2 and 15% KDIGO1. Creatinine values ​​are summarized in Table 1. We found significant differences in the baseline/high creatinine differential; these differences were lost after hospitalization. The main types of AKI were prerenal (35%) and acute tubular necrosis secondary to sepsis (ATN) (53%). 89% of patients with ATN presented AKI KDIGO 3, compared with 57% in the prerenal group (P A total of 89 patients died during the study; 65% of ATN AKI patients versus 31% of prerenal-AKI patients (P CONCLUSION AKI in hospitalized patients with COVID19 presented with two different clinical patterns. Prerenal AKI more frequently affected older, more comorbid patients, and with a mild COVID19 infection. The NTA AKI affected younger patients, with criteria of severity of infection and multiplying mortality almost three times. In analytical control 1-month post-hospitalization, most of the patients recovered their kidney function. Although the implications of AKI associated with COVID-19 in the development of chronic kidney disease are still unclear, our data suggest that most patients will recover kidney function in a medium term.

BACKGROUND AND AIMS The new advances in cancer treatments and the increasing prevalence of kidney disease in the population with cancer have extended the indication of kidney biopsies. The purpose of the study is to analyze clinical and histological characteristics of patients with active solid organ malignancy that underwent kidney biopsy. METHOD Multicenter collaborative retrospective registered study supported by two working groups GLOSEN/Onconephrology from the Spanish Society of Nephrology. Clinical, demographical and histological data were collected. Comparison of continuous variables between two groups was performed by Student’s T-test, and Cox survival analysis adjusted for clinical conditions was performed to identify risk factors associated with mortality. RESULTS A total of 148 patients with cancer who underwent a kidney biopsy from 12 hospitals were included. About 64.3% men and mean age 66.9 years old. The indications for biopsy were acute renal failure (67.1%), proteinuria (17.1%) and acute on top of chronic kidney disease (8.2%). The most frequent malignancies were lung (29.1%) and abdominal (25%), with 49.7% metastatic cancer. As oncospecific treatment, 28.3% received chemotherapy, 29.9% immunotherapy, 19.3% specific therapies and 2.1% conservative treatment (Figure 1) At the time of kidney biopsy, median creatinine was 2.58 mg/dL [1.81–4.1(IQ 25–75)], median urine protein/creatinine, 700 mg/g [256–2463 (IQ 25–75)] and 53.1% presented hematuria. The renal biopsy diagnosis most frequent was acute interstitial nephritis (39.9%), followed by acute tubular necrosis (8.8%) and IgA nephropathy (7.4%). Acute interstitial nephritis was more frequent in the period from 2017 to 2021 as compared with the period from 2010 to 2016 (P = 0.001). About 67.1% received corticosteroids and 18.9% required kidney replacement therapy. Median follow-up was 15.2 months [5.7–31.4 (IQ 25–75)]. The only factor associated with mortality was the presence of the metastasis at the time of kidney biopsy (P = 0.006). CONCLUSION There is a new trend in kidney disease and patients with cancer in terms of diagnosis and treatment. At present, acute interstitial nephritis has consolidated as the most common kidney pathology in this population. Renal biopsy is valuable tool for diagnosis, treatment and prognosis of solid organ cancer patients with kidney damage.

BACKGROUND AND AIMS There is evidence that cancer risk is increased in people with chronic kidney disease (CKD), specially when glomerular filtration rate decreases [1,2]. This association do appear to be site-specific [3,4]. Cancer incidence increases by time since first dialysis in addition [5]. The aim of our study is to describe characteristics of dialysis incident patients with diagnosis of malignancy in a multicentre spanish cohort. METHOD We performed a multicentre collaborative retrospective study over the period 2015–20 of clinical and demographical data from incident dialysis patients with diagnosis of cancer. Data from Seville, Cadiz, Marbella and Huelva was collected from the Registry of Renal Patients of the Andalusian Health Service (SICATA). Data from Canary Islands was collected from Registry of Renal Patients of the Canary Islands Health Service. Data from Cantabria was collected from the Registry of Renal Patients of Cantabrian Health Service. Rest of centres provided their own collected data (Gregorio Maranon General University Hospital and University Hospital October 12). Statistics: Quantitative variables are expressed as mean/-SD (normal distribution) or median (IQ 25–75) (non-normal distribution). Qualitative variables are expressed as percentage. RESULTS 727 incident dialysis patients were diagnosed with cancer before (79.9%) or after (20%) starting dialysis over the study period. Prevalence was 15.9% among all incident patients. 73.2% of patients were men with a mean age 70.1 (SD 10.3) years old. At the time of starting dialysis, 30.6% were smokers, 45.5% patients presented diabetes, 88% high blood pressure, 18.5% received immunosupresive therapy in the past, 4.1% had history of hepatitis B, C or HIV infection and mean proteinuria was measured in 2990 mg/g (SD 3832). Diabetic kidney disease and chronic tubulointerstitial nephritis were the most common causes of CKD (22.1% and 22.9%, respectively). 14.4% of patients had history of glomerular nephropathy. Mean time from CKD diagnosis to dialysis start was 6 years and from CKD diagnosis to cancer diagnosis was 5.4 years (SD 6.4). Solid cancer was found in 88% of patients and 12% had hematological malignancy. Most common malignancies were urinary tract cancers (bladder, 17%, kidney 17.3% and prostate 13.2%) followed by colon cancer, 11.27% of cases. 32% of patients had active neoplasia at the time of starting dialysis and 15.1% had metastatic disease. 33.8% of patients died over follow-up. Neoplastic disease was the most common cause of death (29.6%) followed by cardiovascular (19.5%) and infectious disease (16.2%). A total of 7.1% of patients underwent kidney transplant (previous malignancies were prostate, kidney cancer and multiple myeloma in majority of these cases). CONCLUSION Among our spanish multicentre cohort of incident dialysis patients, the average duration between the diagnosis of CKD and cancer was 5.4 years. The most commonly observed cancer sites were urinary tract and kidney malignancies, as previously reported in other cohorts. Study findings may be a useful reference for cancer screening guidelines in our population.

SARS-CoV-2-pneumonia emerged in Wuhan, China in December 2019. Unfortunately, there is lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), even less in patients on maintenance hemodialysis (MHD) therapy than in the general population. In this retrospective observational single-center study we analyzed the clinical course and outcomes of all MHD patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real time polymerase chain reaction. Baseline features, clinical course, laboratory data, and different therapies were compared between survivors and non-survivors to identify risk factors associated with mortality. Among the 36 patients, 11 (30.5%) died and 7 could be discharged within the observation period. Clinical and radiological evolution during the first week of admission were predictive of mortality. Among the 36 patients, 18 had worsening of their clinical status, as defined by severe hypoxia with oxygen therapy requirements greater than 4 Liters/minute and radiological worsening. Significantly 11 out of those 18 patients (61.1%) died. None of the classical cardiovascular risk factors in the general population were associated with higher mortality. However, a longer time on hemodialysis (hazard ratio 1.008(95% confidence interval 1.001-1.015) per year), increased LDH levels (1.006(1.001-1.011), and lower lymphocyte count (0.996 (0.992-1.000) one week after clinical onset were all significantly associated with higher mortality risk. Thus, the mortality among hospitalized hemodialysis patients diagnosed with COVID-19 is high. Lymphopenia and increased LDH levels were associated with poor prognosis., Graphical abstract

There are limited data describing the long-term renal outcomes of critically ill COVID-19 patients with acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) and invasive mechanical ventilation.In this retrospective observational study we analyzed the long-term clinical course and outcomes of 30 critically ill patients hospitalized with COVID-19 during the peak of highest incidence in the first wave, with acute respiratory distress syndrome (ARDS) and AKI that required CRRT. Baseline features, clinical course, laboratory data, therapies and filters used in CRRT were compared between survivors and non-survivors to identify risk factors associated with in-hospital death. Renal parameters: glomerular filtration rate, proteinuria and microhematuria were collected at 6 months after discharge.19 patients (63%) died and 11 were discharged. Mean time to death was 48 days (7-206) after admission. Patients with worse baseline renal function had higher mortality (Mortality among critically ill hospitalized patients diagnosed with COVID-19 on CRRT is extremely high (63%). Baseline renal function is a predictor factor of mortality. Filters with adsorption capacity did not modify survival. None survivor patients required long-term dialysis, but an important loss of renal function occurred after AKI episode related to COVID-19 infection.La interacciónde COVID-19, ventilación mecánica invasiva (VMI) y fracaso renal agudo (FRA) con necesidad de terapia continua de reemplazo renal (TCRR) es conocida, pero hay pocos datos publicados sobre el pronóstico a largo plazo de este tipo de FRA.Este estudio analiza los resultados a largo plazo de 30 pacientes ingresados en la UCI por neumonía por COVID-19, con VMI y FRA con TCRR en el pico de máxima incidencia. Comparamos las características basales, la evolución clínica y bioquímica y los diferentes filtros usados en la TCRR para identificar los factores de riesgo asociados a la muerte intrahospitalaria. Se analizaron el filtrado glomerular estimado (FGe), la proteinuria y la hematuria a los 6 meses de seguimiento de los supervivientes.De los 30 pacientes, 19 fallecieron y 11 fueron dados de alta. Los pacientes con peor función renal tuvieron mayor mortalidad (p = 0,009). Los filtros usados con capacidad adsortiva no ofrecieron beneficios en cuanto a la supervivencia. De los 11 supervivientes, ninguno requirió terapia renal sustitutiva (TRS) una vez superada la infección, pero tuvieron una pérdida importante y mantenida en el tiempo de función renal (FGe de 44 ml/min/1,73 mLa mortalidad en pacientes con neumonía por COVID-19 que requieren VMI y TCRR es extremadamente elevada (63%). Los filtros con capacidad adsortiva no modificaron la supervivencia. La función renal basal fue un factor predictor de mortalidad. En este tipo de FRA el deterioro de la función renal no se recupera, objetivándose una reducción importante del FGe a los 6 meses.

COVID-19 has had a negative impact on the living conditions of people in all countries worldwide. With a devastating economic crisis where many families are finding it difficult to pay bills and make ends meet, increases in prices of food basket staples can be very worrying. This study examines the relationship between the incidence of the pandemic during the first wave in 16 Eurozone countries with the variation experienced in food prices. We analysed the harmonised index of consumer food prices (included in HICP) and the classification of the degree of pandemic impact by country, the latter established with the index of deaths provided by the Johns Hopkins Center. The procedure used compared actual food prices during the first wave (March to June 2020) with those foreseeable in the absence of the pandemic. Time series analysis was used, dividing the research period into two phases. In both phases, the Holt–Winters model was applied for estimation and subsequent prediction. After a contrast using Kendall’s tau correlation index, it was concluded that in the countries with the highest death rates during the first wave, there was a higher increase in food prices than in the least affected countries of the Eurozone.

Background and Aims Some decades ago, patients with cancer were not submitted to invasive procedures because of their short life expectancy. This is one of the main reasons why data about kidney histology in oncological patients with kidney impairment is very scarce: kidney biopsies were not performed in this population. However, renal biopsy is an especially useful diagnostic and prognostic tool in these patients when they develop kidney injury. The aim of our study is to study clinical and histological characteristics of patients with active solid organ malignancy that underwent kidney biopsy in a multicenter cohort. Method We performed a multicenter collaborative retrospective study. Clinical, demographical, and histological data from patients with an active neoplasia or in active cancer treatment who underwent kidney biopsy were collected. Statistics: Quantitative variables are expressed as mean+/-SD (normal distribution) or median (IQ 25-75) (non-normal distribution).Qualitative variables are expressed as percentage. Actuarial survival curves were performed using Kaplan-Meier. Results 94 patients with cancer who underwent a kidney biopsy during the study period, from 9 hospitals were included.63.8% men, 36.2% woman and mean age 66 (SD +/- 10,95) years old. The indications for biopsy were acute renal failure (63.8%), proteinuria (17%), and exacerbation of chronic kidney disease (11.7%). At the time of the renal biopsy, 27.7% patients presented diabetes, 60.6% high blood pressure, 10.6% were on non-steroidal anti-inflammatory drugs treatment, and 74.5% were receiving renin angiotensin system blockers. Malignances were lung (31.9%), intestinal (13.8%) and prostate (8.5%), with 43.6% metastatic cancer. As oncospecific treatment, 33% received chemotherapy, 30.8% immunotherapy (of which 37.93% received more than 1 checkpoint inhibitor (CPI) and 24.13% had immune-related adverse events), 22.4 % specific therapies, 17 % surgery, and 3.2% conservative treatment. Previously to kidney injury, 51.06% presented Cr> 1 mg / dL. At the time of kidney biopsy, median creatinine was 2,63mg/dL [1,75-3,9 (IQ 25-75)], median urine protein/creatinine ratio 795 mg/g [221-3182(IQ 25-75)]; 51.1% presented haematuria and 22.3% nephrotic range proteinuria; 8.5% eosinophiluria and 7.44% hemolytic anemia and /or low platelet. At the time of renal biopsy, 8.5% presented ANCA and 5.31% decrease in C3 / C4 serum levels. The renal biopsy diagnosis was: 40.4% acute interstitial nephritis, followed by acute tubular necrosis (9.6%), thrombotic microangiopathy (6.4%), membranous nephropathy (5.3%) and IgA nephropathy (6.4%). 62.8% received corticosteroids (28.81% pulses) for an average of 5.8 months [3.7-9.1(IQ 25-75)]. 12.8% required kidney replacement therapy. 43.6% showed complete recovery of kidney function at the end of follow-up. Average follow-up 22.59 months. 40.2% of patients died at the end of follow-up and 72.34 % presented chronic kidney disease. As expected, and maybe related to the heterogeneous cancer disease studied, the only factor associated with mortality was the presence of the metastasis at the moment of kidney biopsy (p=0.028). Conclusion Histological kidney diagnosis in patients with active cancer involves various renal disorders, such as acute interstitial nephritis, thrombotic microangiopathy, membranous nephropathy and IgA nephropathy. Renal biopsy in this group of patients provides valuable diagnostic and prognostic information. More studies are needed to expand the consensus in the diagnosis and treatment of oncological patients with renal injury.

Background and Aims Although metformin-associated lactic acidosis (MALA) is a very rare event, is frequently seen in patients on metformin with risk factors for developing acute kidney injury (AKI). The long-term prognosis in patients with metformin-associated lactic acidosis (MALA) and renal failure remains unknown. To describe the characteristics and prognosis of AKI in patients with MALA and investigate whether prescription of RRT and previous renal function are associated with long-term outcomes. Method A retrospective single-centre case series. One hundred and nine patients affected with MALA and AKI admitted between Marx 2007 and February 2019 were included. We analysed comorbidities, laboratory tests, clinical parameters and prescription pattern of RRT at admission. After discharging, renal outcomes (doubling serum creatinine or starting dialysis) and mortality were assessed in the long-term. Results We included 109 patients (59 males and 50 females), mean age of 74.2±8.6 years and mean Charlson comorbidity index of 8.0±2.4. 54 out of 109 patients had previous chronic kidney disease (eGFR < 60 ml/min/1.72 m2). Precipitating causes of AKI associated MALA included; acute dehydration (84.4%), exposure to iodinated contrast (7.3%) and non-specified causes (8.3%). During the admission, renal replacement therapy (RRT) was performed in 72 patients (continuous renal replacement therapy in 47 and dialysis in 25). RRT requirements was significantly associated with lactate, acidosis and serum creatinine levels, but not was associated with higher mortality rate during admission. The patients were followed a median time of 33 (10-65) months after discharging. 33 patients had a renal event and 55 patients died. The patients with CKD before admission had higher number of renal events (log Rank 6.346, p=0.012) and higher mortality (log Rank 12.943, p Conclusion The renal function prior to the episode of AKI associated to MALA and the RRT at admission are the main factors related to renal outcomes and mortality in the long-term.

A man in his 60s presented with increased oedema in the lower limbs and dyspnoea. Chest X-ray showed right pleural effusion and a body CT scan revealed a severe right pleural effusion as well as presence of solid nodules and pleural plaques. It was decided then to obtain a CT-guided pleural biopsy. Pathology of this biopsy showed an epithelioid mesothelioma. Blood test showed hypoproteinaemia (4.2 g/dL) with hypoalbuminaemia (2.2 g/dL), proteinuria of 1.4 g /24 hours and non-oliguric acute renal failure with serum creatinine of 3.28 mg/dL. A renal biopsy was performed (online supplementary appendix 1). ### Supplementary data [jclinpath-2019-206298supp001.pdf] Review the high quality, interactive digital Aperio slides at http://virtualacp.com/JCPCases/jclinpath-2019-206298/001/, http://virtualacp.com/JCPCases/jclinpath-2019-206298/002/, and http://virtualacp.com/JCPCases/jclinpath-2019-206298/003/, and consider your diagnosis. 1. A (secondary) amyloidosis 2. Collapsing variant of focal segmental glomerulosclerosis 3. Diabetic nephropathy 4. Membranous nephropathy 5. Minimal change disease. The correct answer is after the Discussion. A clinical suspicion of secondary membranous nephropathy (MN) was made due to the increase …

Nowadays, a lot of studies are trying to measure happiness. There are many indexes that measure progress. We have chosen two of them: Happy Planet Index (HPI) and World Happiness Report (WHR). The first of them, an index from New Economics Foundation, is a measure of sustainable well-being in terms of how countries support their citizens to live good lives now and in the future. It uses global data on experienced well-being, life expectancy, and Ecological Footprint from 151 countries. On the other hand, the WHR, an index from the United Nations and Columbia University for 156 countries, uses six factors to explain this: Gross Domestic Product (GDP) per capita, years of healthy life expectancy, social support, perceptions of corruption, generosity, and freedom to make life choices. Both indexes have used different methodology to measure happiness so some countries present different levels of happiness depending on the index that is used. The first objective of this chapter is to propose a new index, using factor analysis to classify 145 common countries between HPI and WHR and to simplify the ranking in four parts. We found that there are areas like South America that could be considered “happy,” independently of the index (HPI, WHR, new index) and vice versa. Therefore, because there is not a unified measure of happiness at the moment we try to reach an agreement between both of them with this new index. Without a doubt, worrying about happiness, at an international level, has caused many countries to fight for a privileged place in the rankings published periodically. Big corporations and global brands are also aware of this situations, where, very often, an association is made between brand’s names and attributes like subjective well-being or happiness; a struggle exist in the consumer’s mind because brands want to be perceived as vectors to reach the subjective and/or collective well-being. Thus, the second objective of this chapter is to confirm that there exist an association between the level of happiness of a country, according to the new index proposed, and the valuation that consumers make of brands’ contribution to their level of well-being, taking the last Havas’s group study Meaningful brands. This work also delves in the relation between the optimism percentage about the future situation and the valuation that citizens do of brands contribution in their well-being level.

In recent years, the concept of cultural intelligence has received increasing attention by researchers and professionals because of its theoretical and practical importance. To understand why some individuals adapt more effectively than others to culturally different social contexts has become a goal with implications for education, recruitment and the prevention of social conflict. The goal of this study was to adapt the Cultural Intelligence Scale (CQS) to Spanish. To do so, two studies were carried out. In the first, the psychometric properties generated by the CQS on a Spanish sample (N = 413) were analysed. In the second study, a confirmatory replication of the factor structure and reliability of the CQS was performed with a different Spanish sample (N = 526) from the first study. The results indicated that the Spanish version of the Cultural Intelligence Scale can be considered a useful and appropriate tool to be used with psychometric guarantees in the Spanish-speaking population.

Over the last few years the Fundacion Secretariado Gitano has organised several awareness campaigns aimed at improving the public image of the gypsy community, breaking down the stereotypes and providing a more credible concept of the Spanish gypsy community. These campaigns are intended to guarantee equal treatment and opportunities for this group. One of its first activities was a mass publicity campaign aimed at making the general public aware of how unfair it is to generalize. In this way the origins of the social image problem suffered by gypsies was tackled. The campaign titled ‘Get to know them before you judge them’ is the objective study of this case in which elements are analysed and decision-making steps are followed. Copyright © 2011 John Wiley & Sons, Ltd.

Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI).Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded.Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI.Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

Cidofovir is an antiviral drug with activity against a wide array of DNA viruses including poxvirus. The therapeutic use of cidofovir is marred by a dose-limiting side effect, nephrotoxicity, leading to proximal tubular cell injury and acute renal failure. Treatment with cidofovir requires the routine use of prophylactic measures. A correct knowledge of the cellular and molecular mechanisms of cidofovir toxicity may lead to the development of alternative prophylactic strategies. We recently cared for a patient with irreversible acute renal failure due to cidofovir. Renal biopsy showed tubular cell apoptosis. Cidofovir induced apoptosis in primary cultures of human proximal tubular cells in a temporal (peak apoptosis at 7 days) and concentration (10–40 μg/ml) pattern consistent with that of clinical toxicity. Apoptosis was identified by the presence of hypodiploid cells, by the exposure of annexin V binding sites and by morphological features and was associated with the appearance of active caspase-3 fragments. Cell death was specific as it was also present in a human proximal tubular epithelial cell line (HK-2), but not in a human kidney fibroblast cell line, and was prevented by probenecid. An inhibitor of caspase-3 (DEVD) prevented cidofovir apoptosis. The survival factors present in serum, insulin-like growth factor-1 and hepatocyte growth factor, were also protective. The present data suggest that apoptosis induction is a mechanism contributing to cidofovir nephrotoxicity. The prophylactic administration of factors with survival activity for tubular epithelium should be further explored in cidofovir renal injury.