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.

In giant cell arteritis (GCA), involvement of the vertebral arteries is rare with reported rates of 3%–4% for ischemic events secondary to vertebral artery stenosis or occlusion for those patients with GCA. This case study describes a patient who initially presented with acute onset of vertigo but was also found to have transient, side-alternating upper limb neurological findings. While initial imaging showed no vascular abnormalities, it was not until GCA was eventually confirmed with a temporal artery biopsy that the initial scans were shown to have bilateral narrowing of the vertebral arteries. While rare, vertebral artery involvement is an important complication to consider in the setting of GCA due to the high rate of associated mortality, despite immunosuppressive therapy.

Background and aims Ethnicity impacts on disease frequency and severity in patients with Lupus Nephritis (LN). As such data are lacking for Indigenous Australians (IA), we investigated the epidemiology, histopathology and outcomes of biopsy proven LN in the Top End of the Northern Territory, Australia. Methods All patients with biopsy confirmed LN between 2001 and January 2011 were identified from a central database at the Royal Darwin Hospital. Demographics and renal histopathology at first renal biopsy (ISN classification, NIH activity (AI) and chronicity index (CI), immunofluorescence (IF) and electron dense deposit (EDD)) were recorded. Clinical findings and outcomes were retrieved by chart review. Results The total study cohort (n=42, age 30 years; 86% female) included 31 IA patents (74%). The annual LN incidence was 7/100,000 in IA patients versus 0.7/100,000 in non-indigenous (NI) patients (p<0.01). Proliferative LN (class III+IV) was less frequent in IA patients (42% vs. 72%) (p<0.01), but AI (2 vs. 5, p=0.06) and CI (2 vs. 1, p=0.9) scores did not differ significantly. Five and ten year patient survival rates were 69% and 50% for IA and 90% for NI patients, while renal survival was 87% and 53% in IA patients and 100% in NI patients. The leading causes of death were infections (38.6%), end stage renal disease (23%), cardiovascular events (15.4%). Conclusions Biopsy proven LN occurs much more frequently in the IA than in the Causcasion population. While associated with poor patient and renal survival, this is not explained by the histological severity of LN.