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Background: Mitochondria are semiautonomous cell organelles having its own nucleic acid. Mitochondrial DNA (Mt‑DNA) remain in hypomethylated (CpG) state and impose an immunogenic response by binding to the toll‑like receptor (TLR‑9) through the NF‑kB pathway. Innate immune cells recognize the hypomethylated pattern of mt‑DNA and quickly trigger the innate immune response. The immunomodulatory effects of urinary mt‑DNA derived from renal transplant recipients with COVID‑19‑associated acute kidney injury (AKI) have not been studied. Materials and Methods: Healthy donor peripheral blood mononuclear cell (PBMC) was cultured with the urinary Mt‑DNA derived from the renal transplant recipients, who previously developed SARS‑CoV‑2 infection associated AKI. Cell activation was measured by the flow cytometry. In cell pellets, interleukin IL‑6, IL‑10, and Myd88, TLR‑9 mRNA transcript expression was measured by the reverse transcription polymerase chain reaction. The IL‑6 and IL‑10 cytokine levels were measured by the enzyme‑linked immunosorbent assay in culture supernatants. Results: The urinary mitochondrial DNA (umt‑DNA) significantly induces the activation of > 75% of PBMCs. The m‑RNA transcript expression of the inflammatory gene in control versus umt‑DNA treated PBMCs was for IL‑6 (0.99 ± 0.05 vs. 2.18 ± 1.15 au; P = 0.004), MYD88 was (1.00 ± 0.05 vs. 1.55 ± 0.31; P < 0.001), TLR‑9 (1.00 ± 0.05 vs. 3.33 ± 1.37 au; P < 0.001) was upregulated, and the IL‑10 (1.00 ± 0.13 vs. −1.73 ± 0.58; P < 0.001) level was downregulated. However, in PBMC culture supernatants, IL‑6 level in control versus umt‑DNA‑treated groups were (37.50 ± 13.79 vs. 186.9 ± 15.50 pg/mL; P < 0.001), which was significantly higher in umt‑DNA‑treated groups and the IL‑10 (8.80 ± 2.16 vs. 7.60 ± 3.12 pg/mL; P = 0.32) level was similar between the control‑ and umt‑DNA‑treated groups. Conclusions: Urinary Mt‑DNA significantly induces the inflammatory cytokine IL‑6 secretion from the PBMCs through the Myd88‑dependent pathway. [ABSTRACT FROM AUTHOR]

Introduction: People on renal replacement therapy (RRT) have a high risk of COVID‐19 infection and subsequent death. COVID‐19 vaccination is strongly recommended for those on RRT. Data are limited on the immune response of the ChAdOx1 nCoV‐19/AZD1222 (Covishield®) vaccine in patients on RRT. Methods: A prospective cohort of adult (age > 18 years), on RRT in the form of hemodialysis were included and received two intramuscular doses of Covishield®. A blood specimen of 5.0 mL was collected at two time points, within a few days before administering the first dose of the vaccine and at 4–16 weeks after the second dose. According to their prior COVID‐19 infection status, the participants were grouped as (i) prior symptomatic COVID‐19 infection, (ii) prior asymptomatic COVID‐19 infection, and (iii) no prior COVID‐19 infection. Results: A large proportion (81%) of participants had anti‐spike antibodies (ASAb) before vaccination, and a reasonable proportion (30%) also had neutralizing antibodies (NAb). The titer of ASAb was relatively low (207 U/mL) before vaccination. The ASAb titer (9405 [1635–25,000] U/mL) and percentage of NAb (96.4% [59.6–98.1%]) were markedly increased following the administration of two doses of the vaccine. The participants' prior COVID‐19 exposure status did not influence the rise in ASAb titer and NAb percentage. Further, administering two doses of the Covishield vaccine helps them achieve a high ASAb titer. Conclusion: Two doses of ChAdOx1 nCoV‐19/AZD1222 (Covishield®) vaccine, given 12 weeks apart, achieve a high titer of ASAb and a high percentage of NAb in people on hemodialysis. [ABSTRACT FROM AUTHOR]

Introduction: Lower respiratory tract infections (LRTIs) among renal transplant recipients (RTRs) are a significant cause of morbidity and mortality. This study aimed to analyse the aetiology, outcome, and risk factors associated with mortality. Methods: We analysed baseline transplant characteristics, symptoms, hospital course, laboratory, serological and microbial results, and their association with the outcome of all RTRs between January 2011 and December 2019. Results: A total of 206 LRTI patients out of 1051 RTRs were analysed. The incidence proportion was nearly 22 episodes per 1000 patients per year. The mean age was 39.3 years, with male predominance. Bacterial was the most common aetiology (53%), and staphylococcus was the most common species. Among the fungal causes (14%), 68% had aspergillus infection. More than one-third RTRs died during the hospital course mainly because of bacterial causes (42.6%). The aspergillus infection was the most common fungus associated with 50% mortality. On multi-variate analysis, sepsis, septic shock, and the need for mechanical ventilation independently predicted mortality. Conclusion: Bacterial aetiology was the most common cause; though the fungal aetiology was seen less, it was associated with higher mortality. Mortality in RTR with LRTI was associated with sepsis, septic shock, and the need for mechanical ventilation. [ABSTRACT FROM AUTHOR]

Introduction: The most common complication of percutaneous renal biopsy is bleeding, which can be seen in up to one-third of cases. The aim of this study was to evaluate the effect of prebiopsy administration of intranasal desmopressin acetate in reducing the incidence of biopsy-related bleeding complications in patients with significant renal dysfunction who underwent renal biopsy. Methods: This was a retrospective, observational study of percutaneous native renal biopsies performed at our center from July 2014 to June 2018. Bleeding complication rates of patients with renal failure (estimated glomerular filtration rate [eGFR] <30 mL/minute/1.73 m2 ) who received desmopressin and those who did not receive desmopressin were compared. Results: Desmopressin administration before renal biopsy in patients with eGFR <30 mL/minute/1.73 m2 was associated with a significant reduction of bleeding complications (major and minor together; P = 0.025) and no significant reduction in major complications (P = 0.616) or intervention rates (P = 0.251) when compared with a group that did not receive desmopressin. Conclusions: While prebiopsy intranasal desmopressin use was associated with a significant reduction of overall bleeding complications including major and minor complications, there was no reduction in the rate of other major complications and interventions. [ABSTRACT FROM AUTHOR]