Objective: To describe the prevalence and severity of sleep disorders and circadian alterations in COVID-19 patients four months after the acute phase of the disease. Methods: This was a cross-sectional observational prospective study of patients with mild COVID-19, moderate COVID-19 (requiring hospitalization but no mechanical ventilation), or severe COVID-19 (with ARDS) four months after the acute phase of the disease. All patients underwent a home sleep apnea test and seven-day wrist actigraphy, as well as completing questionnaires to assess sleep quality and mental health. Differences among the three groups of patients were evaluated by ANOVA and the chi-square test. Results: A total of 60 patients were included in the study. Of those, 17 were in the mild COVID-19 group, 18 were in the moderate COVID-19 group, and 25 were in the severe COVID-19 group. Sleep quality, as assessed by satisfaction, alertness, timing, efficiency, and duration scale scores, was found to be impaired in all three groups, which also had a high prevalence of unhealthy sleep, as assessed by the Pittsburgh Sleep Quality Index. The prevalence of insomnia was increased in all three groups, as assessed by the Insomnia Severity Index. The home sleep apnea test showed that the overall prevalence of obstructive sleep apnea was 60%, and seven-day wrist actigraphy showed that total sleep time was < 7 h in all three groups. Changes in quality of life and in the circadian rest-activity pattern were observed in all three groups. Conclusions: Sleep-related symptoms, changes in the circadian rest-activity pattern, and impaired mental health appear to be common in COVID-19 patients four months after the acute phase of the disease, severe COVID-19 being associated with a higher prevalence of obstructive sleep apnea. Keywords: Sleep apnea, obstructive; Sleep disorders, circadian rhythm; COVID-19.

The association between Takayasu’s arteritis and membranous nephropathy is uncommon. We present the case of a 46-year-old man with Takayasu’s arteritis treated over 10 years by a multidisciplinary medical team. He had an atrophic left kidney due to arterial stenosis, with a basal creatinine of 1.59 mg/dL (140.55 µmol/l). Three years ago, he presented with full nephrotic syndrome, uncontrolled blood pressure, creatinine increases to 4.5 mg/dL (basal: 1.59 mg/dL), severe hypoalbuminaemia (1.4 g/dL) and albuminuria of 24.6 g per day. He underwent percutaneous biopsy of the right kidney that showed membranous nephropathy with negative PLA2R1 and positive IgG 1, 3 and 4 subclasses. After therapy with oral prednisone and cyclophosphamide, the patient’s kidney function improved, without recurrence of disease after 3 years of follow-up. Here, we present this extremely uncommon association of Takayasu’s arteritis and membranous nephropathy.

Key Clinical Message: The commonest renal involvement after bee stings is acute kidney injury due to rhabdomyolysis. Nephrotic syndrome combined with AKI is unusual complication of Hymenoptera stings. We diagnosed a minimal change disease and six‐year follow up relapses.

I am a Chilean Physician, joining a nephrology team that work in a middle size town at Chilean south in both a public hospital named Victor Ríos Ruiz (CAVRR) Los Angeles Biobio Chile and San Sebastian University, a prestigious private university, with more than 30 years of medical education in our hospital [1]. Our team always want to do research choosing cases of interest for sharing with other medical communities, as the case on “Relapsing nephrotic syndrome with acute renal failure following a unique episode of multiple bee stings: A case report”, which has been recently published. We were pleasantly surprised with the request for your journal to write a letter to the editor regarding our case report and satisfied of being considered for this honour.

Introduction: Renal vasculitis is a rare disease, the incidence of which increased markedly during the COVID-19 pandemic in our center. The aim of this study is to compare the incidence and the clinical and histopathological characteristics of anti-neutrophil cytoplasm antibodies (ANCA)-associated vasculitis patients before and during the COVID-19 pandemic.Methods: A single-center observational retrospective analysis of 61 patients with ANCA-associated vasculitis who were divided into two groups according to date of diagnosis: pre-pandemic from 2008 to 2020 (n=37) and during the pandemic from 2020 to the middle of 2022 (n=24). The annual incidence rate was compared, as were characteristics such as age, gender, Birmingham Vasculitis Activity Score (BVAS) score, renal clinic, organ involvement, and ANCA serotype. Biopsy findings, such as optical microscopy glomerular characteristics, crescents, interstitium, immunofluorescence, and electron microscopy findings, were analyzed. Mortality and renal replacement therapy needs were also compared.Results: The annual incidence rate was higher in the pandemic group compared to the pre-pandemic group, with 9.6 cases per year vs. 3.1 cases per year [incidence rate ratio (IRR)=3.11, 95% CI 1.86 to 5.20]. No significant differences between the groups were found for clinical characteristics, except for greater hemoptysis frequency in the pandemic group. Significant differences in immunofluorescence and electronic microscopy were observed, with a higher IgG deposit and C3 in the pandemic group (37.5% vs 8.1%, p=0.0064; 43.5% vs 10.8%, p=0.009, respectively), whereas the incidence of pauci-immune patterns was higher in the pre-pandemic group (81.1% vs 54.1%, p=0.016). Mortality and the need for renal replacement therapy were significant higher in the pandemic group (IRR=3.56, CI 95% 1.27–9.98 and IRR=4.24, CI 95% 2.08–8.65, respectively)Conclusion: The incidence of ANCA vasculitis increased during the COVID-19 pandemic and was associated with higher rates of IgG deposit and C3 in the immunofluorescence findings and with higher rates of deaths and dialysis in the pandemic group compared with the pre-pandemic group.