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available at https://pubmed.ncbi.nlm.nih.gov/30588547/ Editorial Comment: The authors performed a retrospective cohort study of 195 infants between 0 and 2 months old with urinary tract infection. This was a subset of 440 infants with urine cultures that were positive with more than 10 CFU/ml with a midstream sample or a single urinary pathogen with a count of 10,000 to 50,000 CFU/ml obtained by catheterization with associated pyuria or elevated inflammatory markers (C-reactive protein greater than 5 mg/l, white blood cell count 20,000/ml or greater, or neutrophil count greater than 9,000/ml), or any growth of a single urinary pathogen in urine obtained by a suprapubic aspiration defined infection. Higher numbers of infants had grade III to V vesicoureteral reflux if they were infected with pseudomonas, had a higher white blood cell count (15,000/ml vs 12,000/ml), had a higher blood neutrophil percentage (65% vs 46%) and a higher absolute neutrophil count (9,000/ml vs 5,000/ml), and had a lower lymphocyte count (3,000/ml vs 5,000/ml) and a higher neutrophil-to-lymphocyte ratio (2.6 vs 1.3). Abnormal findings on prenatal ultrasound were also more frequent in infants with grade III to V reflux, as was the presence of abnormal postnatal renal ultrasound (84% vs 55%). The best single marker for grade III to V vesicoureteral reflux was blood neutrophil percentage greater than 53%, which demonstrated a sensitivity of 100% for detection of grade III to V reflux, and neutrophil lymphocyte ratio greater than 1.65, which showed a sensitivity of 100% and specificity of 61% for detection of grade III to V vesicoureteral reflux. Infants younger than 2 months admitted with a urinary tract infection are at risk for grade III to V vesicoureteral reflux and will require voiding cystourethrography if the renal ultrasound is abnormal or if they have a pseudomonas urinary tract infection. We should consider avoiding use of voiding cystourethrography in afebrile infants and in infants with a blood neutrophil percentage of less than 53% or a neutrophil-to-lymphocyte ratio of less than 1.65. Douglas A. Canning, MD Renal Transplantation and Renovascular Hypertension Re: Impact of Tocilizumab (Anti-IL-6R) Treatment on Immunoglobulins and Anti-HLA Antibodies in Kidney Transplant Patients with Chronic Antibody-Mediated Rejection B. Shin, M. Everly, H. Zhang, J. Choi, A. Vo, X. Zhang, E. Huang, S. Jordan and M. Toyoda Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Terasaki Research Institute, Comprehensive Transplant Center, Cedars-Sinai Medical Center, and HLA and Immunogenetics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California Transplantation 2020; 104: 856e863. doi: 10.1097/TP.0000000000002895 Abstract available at https://pubmed.ncbi.nlm.nih.gov/31385933/available at https://pubmed.ncbi.nlm.nih.gov/31385933/ Editorial Comment: Tocilizumab (TCZ) is a U.S. Food and Drug Administration approved IL-6 receptor inhibitor that is used for treatment of rheumatoid arthritis and other autoimmune diseases. It has been used recently in some COVID-19 cases to reduce the “cytokine storm” thought in part to be driven by IL-6. This study assesses a transplant related application of the drug. The authors describe Immunoglobulin G (IgG) and donor specific antibody (DSA) levels in archived plasma samples of patients treated with TCZ for chronic antibody mediated rejection (cAMR). TCZ has been used as a rescue agent for cAMR. The authors identified that the study RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION 1085 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.