ABSTRACT
The burden of chronic kidney disease is increasing throughout New Zealand, resulting in growing strain on patients, families and the healthcare system. The population of South Auckland is the most diverse in New Zealand and it is particularly vulnerable to the effects of chronic kidney disease due its demography and its many communities that endure significant hardships. This article explores the prevailing challenges identified by renal physicians and nurse specialists over 35 years of caring for patients with chronic kidney disease in South Auckland.
Subject(s)
Renal Insufficiency, Chronic , Humans , New Zealand , Renal Insufficiency, Chronic/therapyABSTRACT
Membranous nephropathy has been associated with demyelinating polyneuropathies and antiglomerular membrane disease; however, an association with vasculitic neuropathy has not been described. This case describes a patient with biopsy-proven idiopathic membranous nephropathy and synchronous mononeuritis multiplex secondary to idiopathic small vessel vasculitis, who presented with lower limb microvascular ischaemia, peripheral neuropathy and active urinary sediment. Her extensive non-invasive screening for immunological disease and radiological investigations for occult malignancy were unremarkable. The patient received intravenous methylprednisolone and intravenous rituximab induction therapy resulting in complete remission of both the idiopathic membranous nephropathy and small vessel vasculitis at 7 months post treatment.
Subject(s)
Glomerulonephritis, Membranous , Mononeuropathies , Neoplasms, Unknown Primary , Peripheral Vascular Diseases , Vasculitis , Female , Humans , Glomerulonephritis, Membranous/complications , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, Membranous/drug therapy , Vasculitis/complications , Vasculitis/diagnosis , Vasculitis/drug therapy , Mononeuropathies/diagnosis , Mononeuropathies/drug therapy , Mononeuropathies/etiology , Administration, IntravenousABSTRACT
INTRODUCTION: Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Maori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared. RESEARCH DESIGN AND METHODS: As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Maori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model. RESULTS: The HRs for developing any CKD, CKD stages II-V for Maori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively. CONCLUSIONS: Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
Subject(s)
Diabetes Mellitus, Type 2 , Renal Insufficiency, Chronic , Humans , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , New Zealand/epidemiology , Renal Insufficiency, Chronic/epidemiology , Ethnicity , Native Hawaiian or Other Pacific IslanderABSTRACT
BACKGROUND: Patients' expectations may influence prescribers' decisions about antibiotic prescribing for upper respiratory tract infection (URTI). We examined whether a history of an antibiotic related adverse drug reaction (aADR) influenced a person's perception about the safety of antibiotics or their expectation of receiving an antibiotic prescription for an URTI. METHODS: We developed a questionnaire and surveyed 103 hospital inpatients, 38 of whom (37%) reported past experience of aADR. RESULTS: Of the 88 participants who reported recent antibiotic use, participants with a history of aADR reported increased perception of harm from their last antibiotic treatment (P<0.05). Overall, 41/103 (40%) participants expected their doctors to prescribe antibiotics to treat an URTI. Participants' perceptions of antibiotic safety or expectation of antibiotic treatment for an URTI did not differ between those who had personal experience of an aADR compared with those with no history of aADR. CONCLUSIONS: The almost universal belief that antibiotics are safe, beneficial medications, even among people with prior aADR, helps to explain the strong patient expectations for antibiotic treatment in a range of conditions. Educational campaigns about the prescription of antibiotics for viral URTI should include information that the risk of harm far outweighs any potential benefits.
