Background: Immune checkpoint inhibitor therapy (ICI) has greatly changed cancer therapy in recent years. The main side effects are immune-related adverse events (irAEs) that can affect any organ system. With the widespread use of ICIs, even rare irAEs, like acute kidney injury due to ICI-induced nephritis (ICI-AKI), have become a more common complication. Methods: All ICI-treated patients who underwent a kidney biopsy for AKI at a single academic center between January 2020 and December 2023 were analyzed. Results: We identified twelve cases of biopsy-proven ICI-AKI. The median follow up was 11.5 months. All cases showed acute interstitial nephritis (AIN) on the biopsy. Melanoma was the most common cancer, and dual-checkpoint inhibition with Ipilimumab and Nivolumab was the most common regimen. Extrarenal irAEs were present in only 25% of cases. Two-thirds had concomitant medication with proton pump inhibitors (PPIs). Only four patients completely recovered their kidney function, and one patient remained on kidney replacement therapy. Conclusions: AIN is a common cause of AKI in ICI-treated cancer patients. Although they respond well to steroid treatment, full restitution of kidney function occurs in less than half of the subjects. As ICIs are increasingly used in cancer management, more research on the prevention and treatment of ICI-associated AKI is needed.

A20, the central inhibitor of NFκB, has multiple anti-inflammatory properties, making it an interesting target in kidney autoimmune disease and transplant biology. It has been shown to be able to inhibit inflammatory functions in macrophages, dendritic cells, T cells, and B cells in various ways, leading to less tissue damage and better graft outcomes. In this review, we will discuss the current literature regarding A20 in kidney transplantation and autoimmunity. Future investigations on animal models and in existing immunosuppressive therapies are needed to establish A20 as a therapeutic target in kidney transplantation and autoimmunity. Cell-based therapies, modified viruses or RNA-based therapies could provide a way for A20 to be utilized as a promising mediator of inflammation and tissue damage.

Post-Covid syndrome is a debilitating condition which may be caused and/or aggravated by autoantibodies. The current study aimed to determine whether autoantibody depletion by immunoadsorption is effective to reduce the symptom burden of patients with post-Covid syndrome. IAMPOCO was a randomised, patient-blinded, sham-controlled crossover trial of immunoadsorption with tryptophan adsorbers versus sham treatment in patients with post-Covid syndrome at a tertiary academic care centre. The primary outcome was the difference in change in symptom severity before and after the respective therapies. Secondary outcomes included treatment safety, prevalence of autoantibodies against G protein-coupled receptors (adrenergic and muscarinergic receptors), and the influence of treatment on autoantibody levels. 40 patients with post-Covid syndrome and a symptom severity of at least 2 on the Post-Covid-19 Functional Scale were included and randomised to a treatment sequence. There was no difference in change in symptom severity between immunoadsorption and sham; odds ratio in Post-Covid-19 Functional Scale, OR = 1.17 (95% CI, 0.41–3.36; p = 0.771), mean difference in MFI-20 2.4 (95% CI, −3.7–8.5; p = 0.437), in CFS 0.09 (95% CI, −4.5 to 4.7; p = 0.970), in Bell-Scale −2.6 (95% CI, −6.9 to 1.8; p = 0.246), in MoCA score −0.01 (95% CI, −1.2 to 1.1, p = 0.993) and in Handgrip-strength deviation from individual normal value 1.3 (−0.83 to 3.5, p = 0.234). 34 adverse events occurred, 10 during or after sham treatment and 24 during or after immunoadsorption. Autoantibodies against G protein-coupled receptors were depleted by immunoadsorption but not sham treatment. Immunoadsorption was not effective in reducing symptom burden in post-Covid syndrome. Ministry of Health, state of Rhineland-Palatinate; Mainz University Medical Centre; DIAMED Medical Technology. Trial Registration: ClinicalTrials.gov, number NCT05841498.

Donor-transmitted malignancy is a rare and often fatal complication of organ transplantation. We report a case of a 55-year old male kidney transplant recipient who was diagnosed with stage-IV donor-transmitted melanoma 5 months after transplantation with metastases in the liver, spleen, lung, and brain. Immunosuppression was discontinued, and encorafenib and binimetinib, inhibitors of a serine/threonine B-Raf proto-oncogene (BRAF) and mitogen-activated protein kinase kinase (MEK) respectively, were started. Severe rejection ensued and necessitated the start of hemodialysis as well as urgent graft nephrectomy. However, the tumor progressed and BRAF/MEK inhibition was replaced by immune-checkpoint inhibition with ipilimumab and nivolumab. When this also failed to slow disease progression and seizures occurred, therapy with encorafenib and binimetinib was reinstated. Afterwards, most of the metastases remained stable. The patient has now survived for more than 4 years in good general health, which is an exceptionally long survival with donor-transmitted, metastasized melanoma.

Background: The Check-up 35 has been a key element of primary prevention in German general practice since 1989. However, evidence on its effectiveness in detecting target diseases remains limited. Therefore, we analyzed the detection rates of the target diseases of the Check-up 35 in a large cohort of persons treated in German primary care. Methods: In a retrospective cohort study using data from 1,216 German primary care practices (IQVIA™ Disease Analyzer, 2019–2023), we compared Check-up 35 participants with non-participants via 1:5 propensity score matching. We analyzed diagnoses of arterial hypertension, diabetes mellitus, dyslipidemia, and chronic kidney disease (CKD) within three months post-check-up versus a random visit in controls. Medication prescriptions following diagnosis served as a secondary outcome. Results: We compared 51,829 participants with 259,145 matched non-participants. Participation was associated with higher diagnosis rates: hypertension (HR 1.56), diabetes (HR 1.69), dyslipidemia (HR 3.24), and CKD (HR 2.07). The effect was especially pronounced for dyslipidemia in individuals under 40 (HR 5.10). Prescription rates after diagnosis were similar or lower in the Check-up group. Conclusion: Check-up 35 is effective in early detection of key chronic diseases. Broader participation should be encouraged to improve prevention.