Low rate of severe-end-stage kidney disease after SABR for localised primary kidney cancer.

BACKGROUND: Stereotactic ablative body radiotherapy (SABR) is an emerging treatment for patients with primary renal cell carcinoma (RCC). However, its impact on renal function is unclear. This study aimed to evaluate incidence and clinical factors predictive of severe to end-stage chronic kidney disease (CKD) after SABR for RCC. METHODS AND MATERIALS: This was a Single institutional retrospective analysis of patients with diagnosed primary RCC receiving SABR between 2012-2020. Adult patients with no metastatic disease, baseline estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73 m2, and at least one post-SABR eGFR at six months or later were included in this analysis. Patients with upper tract urothelial carcinoma were excluded. Primary outcome was freedom from severe to end-stage CKD, determined using the Kaplan-Meier estimator. The impact of baseline CKD, age, hypertension, diabetes, tumor size and fractionation schedule were assessed by Cox proportional hazard models. RESULTS: Seventy-eight consecutive patients were included, with median age of 77.8 years (IQR 70-83), tumor size of 4.5 cm (IQR 3.9-5.8) and follow-up of 42.2 months (IQR 23-60). Baseline median eGFR was 58 mls/min; 55% (n = 43) of patients had baseline CKD stage 3 and the remainder stage 1-2. By last follow-up, 1/35 (2.8%) of baseline CKD 1-2, 7/27 (25.9%) CKD 3a and 11/16 (68.8%) CKD 3b had developed CKD stage 4-5. The estimated probability of freedom from CKD stage 4-5 at 1 and 5 years was 89.6% (CI 83.0-97.6) and 65% (CI 51.4-81.7) respectively. On univariable analysis, worse baseline CKD (p < 0.0001) and multi-fraction SABR (p = 0.005) were predictive for development of stage 4-5 CKD though only the former remained significant in multivariable model. CONCLUSION: In this elderly cohort with pre-existing renal dysfunction, SABR achieved satisfactory nephron sparing with acceptable rates of severe to end-stage CKD. It can be an attractive option in patients who are medically inoperable.

African American Clergy Perspectives About the HIV Care Continuum: Results From a Qualitative Study in Jackson, Mississippi.

Mississippi has some of the most pronounced racial disparities in HIV infection in the country; African Americans comprised 37% of the Mississippi population but represented 80% of new HIV cases in 2015. Improving outcomes along the HIV care continuum, including linking and retaining more individuals and enhancing adherence to medication, may reduce the disparities faced by African Americans in Mississippi. Little is understood about clergy's views about the HIV care continuum. We assessed knowledge of African American pastors and ministers in Jackson, Mississippi about HIV and the HIV care continuum. We also assessed their willingness to promote HIV screening and biomedical prevention technologies as well as efforts to enhance linkage and retention in care with their congregations. Four focus groups were conducted with 19 African American clergy. Clergy noted pervasive stigma associated with HIV and believed they had a moral imperative to promote HIV awareness and testing; they provided recommendations on how to normalize conversations related to HIV testing and treatment. Overall, clergy were willing to promote and help assist with linking and retaining HIV positive individuals in care but knew little about how HIV treatment can enhance prevention or new biomedical technologies such as pre-exposure prophylaxis (PrEP). Clergy underscored the importance of building coalitions to promote a collective local response to the epidemic. The results of this study highlight important public health opportunities to engage African American clergy in the HIV care continuum in order to reduce racial disparities in HIV infection.

Assessing quality of life among British older people using the ICEPOP CAPability (ICECAP-O) measure.

BACKGROUND: The Investigating Choice Experiments for the Preferences of Older People (ICEPOP) programme developed a capability-based measure of general quality of life (QOL): the ICEPOP CAPability (ICECAP-O) instrument. ICECAP-O was originally intended for use in the economic evaluation of health and social care interventions, but there is increasing interest in using it to quantify differences in QOL in cross-sectional data. OBJECTIVE: The objective of this study was to assess the construct validity of the overall ICECAP-O scores and quantify differences in QOL associated with various factors in a multivariable regression model among residents of a British city. METHODS: ICECAP-O was administered as part of a survey of 4304 citizens of a British city. QOL values in only those respondents aged ≥65 years (n = 809) were compared across subgroups using univariable analyses and multivariable regression models. RESULTS: QOL values were associated with differences in responses to a variety of questions about respondents' socioeconomic status, locality, contact with others, participation, health and social support. Multivariable regression results showed that poor physical and psychological health were associated with 4-7% lower QOL. Living alone and infrequent socializing were each associated with an approximately 2.5% impairment in QOL. Feeling unsafe after dark was associated with an 8% impairment, whilst those without a faith experienced 5% lower QOL on average. Distribution of ICECAP-O values by electoral ward enabled the identification of areas of deprivation, although the associations were strong only for enjoyment and control. CONCLUSION: ICECAP-O provides policy makers with robust quantitative evidence of differences in QOL. It offers local government an opportunity to evaluate the effects of health and other interventions, and to make comparisons across sectors for which it is responsible. It also demonstrates good ability to compare impairments in QOL associated with sociodemographic, health and attitudinal variables.

Kaposi Sarcoma in Patient with Membranous Glomerulonephropathy during Corticosteroid Therapy / 대한신장학회잡지

Membranous glomerulonephropathy is a common cause of nephrotic syndrome in adults. Kaposi sarcoma is a well-known entity with distinct clinical forms such as nodular cutaneous lesions, generalized lymphadenopathy and visceral involvement. Incidence of Kaposi sarcoma is greater in patients with immunosuppression, particularly those having undergone renal transplantation, but also in patients with other underlying disorders treated with immunosuppressive therapy, notably, corticosteroids. We present a case of Kaposi sarcoma in patient with membranous glomerulopathy during corticosteroid therapy. A 49- year-old man was admitted with a complain of facial and leg edema, 5-kg weight gain for 1 month, and foamy urine. Kidney biopsy showed membranous glomerulopathy. We started corticosteroid therapy to the patient. Two month later, his 24 hr urinary protein was decreased to 2.1 g/day. But, the well defined, various-sized, purple-colored papules and plaque appeared on the both hands and feet. He underwent skin biopsy, which revealed abnormally proliferated and dilated vessels, vascular slits, spindle-shaped cells and extravasated erythrocytes in the dermis. The findings were in accordance with Kaposi sarcoma. So he received cryotherapy with discontinuing corticosteroid. Four months after cryotherapy, skin lesions were cleared leaving slight hypopigmentation and amount of proteinuria was preserved without definite aggravation.