Retrospective review of lupus nephritis in a New Zealand multi-ethnic cohort.

Increased lupus nephritis has been reported in Pacific Island and Maori populations. Previous studies suggest ethnic variation in response to immunosuppression treatment; however this has not been assessed in Pacific Island and Maori cohorts. This retrospective study reviewed class 3, 4 and 5 lupus nephritis outcomes and response to induction immunosuppression over a 10-year period in a New Zealand multi-ethnic cohort with high Pacific Island representation. This included 49 renal biopsies in 41 patients; by ethnicity Pacific Island 53.7%, Asian 31.7%, Caucasian 12.2%, and New Zealand Maori 2.4%. There were 11 class 3, 24 class 4 and 17 class 5 either alone or in combination with class 3/4. There were no statistically significant differences in renal function or proteinuria between ethnic groups at baseline. Pacific Island class 3/4 showed similar rates of renal remission with intravenous cyclophosphamide (6/8) and mycophenolate (4/7) induction treatment; results were comparable to the overall study group. There were no deaths or permanent dialysis requirements in the first six months of treatment, and no increased risk of adverse outcomes when stratified by ethnicity. Five lupus nephritis relapses occurred during maintenance treatment and there was no apparent ethnicity bias. CONCLUSION: Pacific Island people disproportionately present with increased lupus nephritis; and had comparable renal remission rates with intravenous cyclophosphamide and oral mycophenolate which were similar to the whole study cohort.

Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study.

BACKGROUND: Our centre introduced peritoneoscopic insertion of peritoneal dialysis (PD) catheter by nephrologists as a new method in August 2009 for its potential benefits. AIM: The aim of this study was to compare perioperative complications and catheter survival of three techniques: peritoneoscopic, surgical and radiological techniques within a single dialysis centre. METHOD: This study used retrospective analysis of all PD catheter inserted from 1 August 2009 to 31 July 2013 within Counties Manukau DHB, Auckland, New Zealand. RESULTS: During the study period, 293 PD catheters were inserted, 84 (29%) peritoneoscopic (P), 140 (48%) surgical (S) and 69 (23%) radiological (R). Total duration of follow-up was 5848 catheter-months, with median follow-up of 17 months. There was no difference in perioperative exit-site infections and overall early infections. There was however increased overall perioperative complications in P compared with R (HR 2.08; P < 0.05), predominantly from catheter removal within 60 days. Although there was no difference observed in first catheter 1-year and overall survival between insertion techniques, there was poorer complication-free survival comparing P to S (HR 1.82, P = 0.001) but not to R. Analyses of the latter cohort of P confirmed improvement in catheter survival compared with an earlier cohort and to other insertion techniques. CONCLUSION: Peritoneoscopic PD catheter insertion is demonstrated to be a suitable alternative technique. As with any new procedure, 'learning curve' effects and development of operator expertise need to be taken into consideration.

Non-diabetic renal diseases in a multi-ethnic New Zealand cohort with type 2 diabetes mellitus: clinical and histopathological features.

The aims of this study were to identify non-diabetic renal disease (NDRD), including obesity related glomerulopathy (ORG) in diabetic patients, and compare the findings with those of pure diabetic nephropathy (DN).Ninety-three renal biopsies from diabetic patients were reviewed retrospectively, along with their clinical findings at biopsy and their estimated glomerular filtration rate (eGFR) over 5 years follow-up. DN and focal segmental glomerulosclerosis (FSGS) were diagnosed on blinded histology review, together with assessment of renal compartment histology. Other NDRD were diagnosed on full review.Most patients were obese with poor renal function at biopsy. NDRD occurred in more than two-thirds of biopsies. FSGS and interstitial nephritis were common. Patients with pure FSGS presented earlier, and had favourable histological features and clinical course. Most FSGS patients fulfilled criteria for ORG. Biopsies with interstitial nephritis showed more functional glomerular tissue, and most patients retained good renal function. Adverse prognostic features were DN versus NDRD, nodular grade of DN, low eGFR at biopsy, and severe chronic histological changes.In this population, ORG mechanisms contribute to renal injury. FSGS is frequent, and should be diagnosed separately from any DN. Biopsy to confirm suspicion of interstitial nephritis should be performed even if retinopathy is present.

Extended high cut-off haemodialysis for myeloma cast nephropathy in Auckland, 2008-2012.

Myeloma cast nephropathy contributes to high morbidity and early mortality associated with the development of end-stage renal disease. Treatment with extended high cut-off haemodialysis coupled with novel anti-myeloma therapies enables significant reduction of serum-free light chains and has been shown to improve renal outcomes. In this case series, medical records of 6 patients who received high cut-off haemodialysis for biopsy-proven cast nephropathy were retrospectively reviewed. Patients received a total of 344 hours of high cut-off haemodialysis and concurrent chemotherapy. Only 50% became dialysis independent following treatment. One patient who achieved sustained remission remained dialysis dependent. The added benefit of high cut-off haemodialysis in the light of novel anti-myeloma therapies requires further evaluation.