ObjectivesThe objective of this study was to evaluate patient compliance with management recommendations given by a breast cancer multidisciplinary team (MDT), assess for reasons for noncompliance, and perform an exploratory assessment on breast cancer outcomes in noncompliant patients.Materials and methodsA retrospective analysis of prospectively collected data was undertaken for patients selected by their primary clinician to be discussed at the MDT of Breast Cancer Research Centre‐WA in Perth between 1st March 2011 and the 28th February 2016. The primary objective was the rate of compliance with MDT management recommendations. Secondary objectives included factors associated with noncompliance, rate of clinical trial uptake, and impact of treatment noncompliance on breast cancer events in a subgroup of early breast cancer (EBC) patients.Results and conclusionA total of 2614 MDT management recommendations were made for 925 patients. Overall, 92% were compliant with all recommendations given. Clinical trial recruitment was successful in 84.1%. The reasons given for treatment noncompliance were fear of toxicity, choosing an alternative treatment, and treatment inconvenience.In a subset of 337 EBC patients, there was a significantly higher rate of contralateral breast cancer, distant recurrence, and breast cancer‐specific death, P = .0016, in those who were noncompliant. Our study demonstrates a high rate of MDT treatment recommendation compliance and clinical trial recruitment. In a subgroup of EBC patients, noncompliance was associated with significantly worse outcomes. Attention to educating patients to minimize their fear of treatment toxicity and ensuring their understanding of evidence‐based treatment may lead to lower rates of noncompliance.

A 75-year-old man with stage IV chronic kidney disease due to type 2 diabetes mellitus, presented with increasing proteinuria and rapidly declining renal function despite excellent glycaemic control. Investigations organised to assess his suitability for renal transplantation included an abdominal CT scan, which revealed extensive intra-abdominal lymphadenopathy. A 17fluorodeoxyglucose (FDG)-positron emission tomography scan to further characterise the lymphadenopathy demonstrated activity in the lymph nodes, as well as both kidneys. Following a lymph node biopsy and flow cytometry he was diagnosed with a marginal zone lymphoma. A subsequent kidney biopsy confirmed lymphomatous infiltration of the kidney. Marginal zone lymphoma is an uncommon type of non-Hodgkin's lymphoma, and renal involvement is rare. This case highlights the importance of considering alternative diagnoses when there is deviation from the expected clinical trajectory and the importance of liaising with colleagues in other disciplines to enable an accurate diagnosis to be made.

Background: Chronic kidney disease (CKD) is on the rise worldwide. It is associated with increased morbidity and mortality and places a huge burden on cost constrained health systems in developing countries such as South Africa. ACE inhibition is well established as major factor of reduction of the decline of renal function. Methods: This is a retrospective cohort study using the medical records of 300 patients attending the outpatient renal clinic department at Inkosi Albert Luthuli Central Hospital for the period January 2007-December 2009. The average patient age was 43 years. The patients were followed up for 24 months following their first clinic visit. Sociodemographic (age sex, residence) and clinical characteristics including eGFR, blood pressure, BMI (body mass index), proteinuria, haemoglobin, cholesterolemia, uricaemia were recorded. Treatments received including ACE inhibitors, statins, non-dihydropyridine calcium channel blockers (NDCCB), Beta blockers were also recorded. Patients were divided into 2 outcome categories, according to changes in eGFR (estimated glomerular filtration rate): patients with eGFR decline of 1ml/ min/year or less and those with accelerated eGFR decline(>1ml/min/ year). Data analysis using SPSS version 23 (IBM) comprised of descriptive tests and logistic regression analysis (expressed as OR (odd ratio) and confidence interval) for the study of the association of above characteristics with patients' outcome. Results: ACE inhibition was used by 92% of patients. Uricaemia and BMI were associated with worsening of eGFR decline OR: 1.012[1.003-1.020] p=0.007 and OR: 3.775[1.116-12.766], p=0.033 respectively. The use of carvedilol and NDCCB was associated with a reduction of the decline of eGFR with OR: 0.144[0.207-0.953] p=0.037 and OR: 0.543[0.329-0.884], p=0.016 respectively. No significant association was found between eGFR change and daily proteinuria or cholesterolemia. The aetiology of the chronic kidney disease did not affect rate of progression of eGFR. In addition the rate of progression was not dependent on eGFR. Patients with high uric acid levels were more prone to progression of chronic kidney disease irrespective of the aetiology. Conclusions: The control of uricaemia and BMI, and use of carvedilol and NDCCB, may lead to a further delay in the progression of chronic kidney disease, beyond ACE inhibition in KwaZulu-Natal.