OBJECTIVETo examine trends in microvascular complications in adolescents with type 1 diabetes between 1990 and 2009 in Sydney, Australia.RESEARCH DESIGN AND METHODSWe used analysis of complications in 1,604 adolescents (54% female, aged 12–20 years, median duration 8.6 years), stratified by four time periods using Generalized Estimation Equations as follows: T1 (1990–1994), T2 (1995–1999), T3 (2000–2004), and T4 (2005–2009). Early retinopathy was detected using seven-field fundal photography, albumin excretion rate (AER) using timed overnight urine collections, and albumin-to-creatinine ratio (ACR) and peripheral nerve function using thermal and vibration threshold.RESULTSRetinopathy declined (53, 38, 23, and 12%; P < 0.001), as did borderline elevation of AER/ACR (45, 30, 26, and 30%; P < 0.001) and microalbuminuria (8, 4, 3, and 3%; P = 0.006). Multiple daily injections (MDI)/continuous subcutaneous insulin infusion (CSII) use increased (17, 54, 75, and 88%; P < 0.001), median HbA1c decreased (9.1, 8.9, 8.5, and 8.5%; P < 0.001), and severe hypoglycemia was unchanged (6, 8, 10, and 7%; P = 0.272). Retinopathy was associated with diabetes duration (odds ratio [OR] 1.12 [95% CI 1.08–1.17]), age (1.13 [1.06–1.20]), HbA1c (1.16 [1.08–1.25]), systolic blood pressure (BP) SDS (1.31 [1.16–1.48]), socioeconomic disadvantage (1.42 [1.04–1.95]), and 1 to 2 injections per day (vs. MDI/CSII; 1.35 [1.05–1.73]); borderline AER/ACR with male sex (1.32 [1.02–1.70]), age (1.19 [1.12–1.26]), HbA1c (1.18 [1.08–1.29]), weight SDS (1.31 [1.21–1.53]), insulin dose per kilograms (1.64 [1.13–2.39]), 1 to 2 injections per day (1.41 [1.08–1.84]), and socioeconomic disadvantage (1.68 [1.23–2.31]); and microalbuminuria with age (1.14 [1.01–1.29]), HbA1c (1.20 [1.05–1.37]), diastolic BP SDS (1.76 [1.26–2.46]), and 1 to 2 injections per day (1.95 [1.11–3.41]).CONCLUSIONSThe decline in retinopathy supports contemporary guidelines that recommend lower glycemic targets and use of MDI/CSII in children and adolescents with type 1 diabetes.

Background IgM nephropathy is a rare disease with variable clinical presentations and is an unusual cause of nephrotic syndrome. Histopathological findings typically include mesangial hypercellularity with IgM and complement deposition, though the spectrum may range from normal glomeruli through to focal and segmental glomerulosclerosis. Thromboembolism is a well recognised complication of nephrotic syndrome, but cerebral venous sinus thrombosis is rarely described. Case presentation This is the case of a 23-year-old male presenting with the nephrotic syndrome, whose initial renal biopsy was consistent with minimal change disease. Complete remission was achieved with prednisone, however multiple relapses and steroid dependence prompted re-biopsy, the results of which were more consistent with IgM nephropathy. His last relapse was complicated by cerebral venous sinus thrombosis. He then received rituximab and a weaning course of prednisone to again enter remission. Conclusions This case highlights the need to consider IgM nephropathy in the differential diagnosis of nephrotic syndrome. Additionally, it emphasises the risk of thrombosis in patients with severe nephrosis.

Boseley M. Australia's mouse plague: six months ago it was war, now whole towns have accepted their presence. The Guardian 2021; 15 May. https://www.thegu ardian.com/austr alia-news/2021/ may/15/austr alias -mouse -plagu e-six-month s-ago-it-was-warnow-whole -towns -have-accep ted-their -presence (viewed Dec 2021).

Context Primary aldosteronism (PA) is a common secondary cause of hypertension. Literature regarding PA in pregnancy has demonstrated poor outcomes. Objective Compare the management and outcomes of PA in pregnancy to both high and low-risk matched controls. Design Case-control Setting Metropolitan hospitals, Sydney, Australia. Patients PA women (positive salt-suppression test) with singleton pregnancies delivered after 20-weeks gestation were matched to women with high- and low-risk pregnancies. Main outcome measures Management outcomes included preeclampsia prophylaxis and antihypertensive medications required prenatally, antenatally and postnatally. Maternal outcomes included incidence of preeclampsia, gestational diabetes, hypokalaemia, mode of delivery and length of stay postpartum. Neonatal outcomes included gestation, birth weight, Intensive Care Unit admission and length of stay. Results Fifty-nine women with sixty pregnancies were included (20 PA, 20 high-risk and 20 low-risk). Women with PA took a similar number of antihypertensive medications pre-pregnancy compared to the high-risk group. A similar proportion of women in the PA and high-risk groups were prescribed preeclampsia prophylaxis and developed preeclampsia. Even after adjustment for several factors, PA was not independently associated with preeclampsia development. Women with PA had higher antihypertensive requirements and a longer stay in hospital postpartum than the high-risk group (both p=0.02). There was no difference in neonatal adverse outcomes. Four women took epleronone during pregnancy without any adverse effects noted. Conclusion Women with PA required more anti-hypertensives and had a longer postpartum length of stay than matched high-risk women, but similar rates of preeclampsia. There was no difference in the rate of NICU admissions or adverse outcomes for neonates.