Renal histology in Indigenous Australians with lupus nephritis.

BACKGROUND: Lupus nephritis (LN) is a feared complication of systemic lupus erythematosus (SLE). Renal biopsy is valuable to assess disease severity and prognosis, but no histological data are available for Indigenous Australians (IA). We compared histopathology between IA and non-IA patients (NI) with LN in northern Australia and describe main outcomes. METHODS: Retrospective cohort study of all patients with biopsy evidence of LN at Royal Darwin Hospital over a 10-year period. Biopsies were classified by International Society of Nephrology criteria with clinical finding and vital status obtained from electronic health records. Data analyses used Australian Bureau of Statistics 2011 census population, nonparametric testing and lifetable estimates. RESULTS: The study cohort contained 42 patients (mean age 30 years,86% female and 74% IA). The estimated annual incidence of biopsy-proven LN was 7/100 000 for IA versus 0.7/100 000 for NI (P < 0.01). More IA patients had full-house immune complex deposition (79% vs. 21%, P < 0.05), but fewer IA patients had proliferative LN (classes III + IV) (42% vs. 72%) (P < 0.01). Five and 10-year patient (69% and 50%) and renal survival (87% and 53%) in IA were much worse than for NI patients. The reported causes of death were infections (38.6%), end-stage renal disease (23%), cardiovascular events (15.4%). CONCLUSION: Indigenous Australians more frequently have histological evidence of LN with a broader spectrum of immune complex deposition but less severe renal inflammation compared to non-Indigenous patients. The relative contribution of LN to reduced patient and renal survival for Indigenous Australians thus requires further study.

Melioidosis and the kidney.

Melioidosis, caused by the saprophytic soil and freshwater Gram-negative aerobic bacillus Burkholderia pseudomallei, is classically characterized by pneumonia, sometimes with multiple organ abscesses, usually in patients with defined risk factors and with a mortality rate of up to 40%. It is a major cause of community-acquired sepsis in Southeast Asia and tropical northern Australia with an expanding global geographical distribution. It is increasingly recognized as an opportunistic infectious disease of importance to physicians, who may need to suspect it in at-risk patients that may come from or visit endemic areas, and could be fatal if treated late or inappropriately. Mortality could be prevented by early institution of specific antimicrobial therapy. Epidemiology, clinical features, overall management, and aspects of melioidosis particularly relevant to kidney disease and immunosuppression are discussed in this review.

Blood-borne viruses in the haemodialysis-dependent population attending Top End Northern Territory facilities 2000-2009.

AIM: To describe the incidence and prevalence of blood-borne viruses (BBV) including: hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and human T-cell leukaemia virus type-1 (HTLV) in the haemodialysis-dependent population of the Top End of the Northern Territory (TENT). METHODS: We retrospectively reviewed the serology of BBV in a longitudinal fashion in the haemodialysis-dependent population treated in the TENT of Australia from 2000 to 2009 inclusive. HBV, HCV, HIV and HTLV serology on commencement of dialysis and at exit or January 2010, whichever was earlier, as well as demographic details were collected. Patients with a change in serological status had all serology reviewed. RESULTS: Four-hundred and forty patients were included in the analysis. Of these, 84.3% were Indigenous and 55.4% female, with a median age of 50 (IQR 43-59) years at the commencement of haemodialysis. Evidence of past HBV infection was documented in 42.7% and 8.9% were hepatitis B surface antigen-positive. Positive serology for HTLV was documented in 2.2%, 1.6% were hepatitis C antibody-positive and no individual was HIV-positive. Three patients had a definite change in their HBV serology over time; this equates to an absolute seroconversion risk of 0.1 per 100 person years or 0.0006 per dialysis episode. CONCLUSIONS: In this cohort, there was a high rate of past and current hepatitis B infection but low rates of seroconversion while on haemodialysis.

High prevalence of vitamin D deficiency in north Indian adults is exacerbated in those with chronic kidney disease.

AIM: Vitamin D is being increasingly recognized as an important player in disease. Hypovitaminosis D is widespread in chronic kidney disease (CKD) populations around the world. The vitamin D status of Indian CKD patients is not known. METHODS: Levels of 25(OH) vitamin D and parathyroid hormone (PTH) were measured in adult north Indian male patients with newly diagnosed stage IV-V CKD and matched control subjects drawn from the same population. A total of 100 (34 stage IV and 66 stage V) patients with CKD and 72 controls were studied. RESULTS: Only 4% control and 1% of CKD subjects had normal (>30 ng/mL) vitamin D levels. Approximately 68% of control and 77% of the CKD population had vitamin D deficiency (<15 ng/ml) whereas the remaining 38% control and 22% CKD patients had insufficient (15-30 ng/mL) vitamin D levels. Levels were lower in CKD subjects compared to their family members, and the CKD patients were significantly more likely to have severe vitamin D deficiency (<5 ng/mL). A strong negative correlation was noted between vitamin D and PTH. No significant correlation was found between vitamin D levels and body mass index, bodyfat percentage, serum albumin or calcium levels. CONCLUSION: Vitamin D deficiency is highly prevalent in north Indians, and this is more pronounced in CKD subjects. There is a significant inverse correlation between the vitamin D and PTH levels. The clinical significance of this deficiency and the potential benefits to be derived from vitamin D supplementation in this population merits further studies.