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.

No abstract

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.

This in-depth review on melioidosis may stimulate attention for Asian countries on this easy to be neglected infectious disease. The importance also relies on the fact that mortality can be prevented by early institution of specific antimicrobial therapy. ABSTRACT: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.

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.

Melioidosis is an infectious disease endemic in tropical northern Australia and Southeast Asia, and, if treated late or inappropriately, is usually fatal. We report a rare case of pleuro-pulmonary melioidosis with septicemia in a renal transplant recipient to highlight the potential risk of acquiring this infection in at-risk patients living in, or visiting, regions that are endemic for melioidosis, and to convey the importance of its early diagnosis and specific treatment.

Abnormalities in mineral and bone disease are common in chronic kidney disease (CKD). Evaluation of bone health requires measurement of parameters of bone turnover, mineralization, and volume. There are no data on bone health in CKD patients from India. In this cross-sectional study, we evaluated serum biomarkers of bone turnover: Bone-specific alkaline phosphatase (BAP) and total deoxypyridinoline (tDPD) along with parathyroid hormone, 25(OH) vitamin D, and bone mineral density (BMD) using dual absorption X-ray absorptiometry in a cohort of 74 treatment-naive patients with newly diagnosed stage 4 and 5 CKD (age 42 ± 14.5 years, 54 men) and 52 non-CKD volunteers (age 40.2 ± 9.3 years, 40 men). Compared to the controls, CKD subjects showed elevated intact PTH (iPTH), BAP, and tDPD and lower BMD. There was a strong correlation between iPTH and BAP (r = 0.88, P < 0.0001), iPTH and tDPD (r = 0.51, P < 0.0001), and BAP and tDPD (r = 0.46, P = 0.0004). The iPTH elevation was greater than twice the upper range of normal in 73% cases, and BAP was >40 U/L in 66% cases. The combination of these markers suggests high turnover bone disease in over 60% cases. The prevalence of osteopenia and osteoporosis was 37% and 12%, respectively. Osteoporotic subjects had higher iPTH, BAP, and tDPD, suggesting a role of high turnover in genesis of osteoporosis. Vitamin D deficiency was seen in 80%, and another 13% had insufficient levels. Vitamin D correlated inversely with BAP (r = −0.3, P = 0.009), and levels were lower in those with iPTH >300 pg/ml (P = 0.0.04). In conclusion, over 60% of newly diagnosed Indian stage 4–5 CKD patients show biochemical parameters consistent with high turnover bone disease. High turnover could contribute to the development of osteoporosis in CKD subjects. Deficiency of 25 (OH) vitamin D is widespread and seems to have a role in the genesis of renal bone disease. Studies on the effect of supplementation of native vitamin D are needed.

Improved immunosuppression regimens have led to better survival for patients with renal transplant grafts and patients with immunological renal diseases worldwide. However, this is not the case in the Northern Territory of Australia. Available limited published data from the Northern Territory of Australia have shown poor outcomes for renal transplantation with survival for both patients and grafts around 50% at 5 years suggesting death with a functioning graft as the commonest cause of graft loss. These studies have shown that the leading cause of death is infections. Achieving the right level of immunosuppression to prevent rejection in renal transplantation and achieve remission in immunological renal diseases can be a major challenge in areas with high prevalence of infections such as the Northern Territory. We present 2 cases of the challenges from infections of immunosuppression in renal transplantation and immunological renal diseases in the Northern Territory of Australia. A 57-year-old Aboriginal woman received a deceased donor renal transplant in 2006. She has been plagued by recurrence of several life threatening infections including urinary tract, cytomegalovirus, and severe cryptococcocus infections. This resulted in immunosuppression reduction and failure of the transplant 5 years post transplantation. A 20-year-old Aboriginal woman presented with a combination of severe lupus nephritis and severe sepsis. She fully recovered after treatment with antibiotics and careful immunosuppression. However, she has had recurrent hospital admissions with life threatening infections resulting in stopping the immunosuppression. She then had severe lupus nephritis flare leading to dialysis dependence and will need a renal transplant. The cases illustrate the need for tailored and robust immunosuppression and transplant work up protocols. To that effect, prospective studies to analyse outcomes in immunosuppressed individuals, pharmacokinetic studies assessing whether the conventionally recommended drug levels are appropriate for this population and culturally appropriate educational programmes need to be performed.