BackgroundTransplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection.Case presentationWe present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression.ConclusionsThis case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.

Background Lupus nephritis (LN) is a common feature of systemic lupus erythematosus (SLE) and affects 50% of patients with SLE. Racial differences in incidence and prevalence have been well documented worldwide. In Australia, higher incidence and prevalence of SLE had been previously reported in Aboriginal and Torres Strait Australians compared with non‐Indigenous Australians. Aim To describe the differences in clinical features and lupus biomarkers between Aboriginal and Torres Strait Islander Australian and non‐Indigenous Australian patients with LN. Methods We retrospectively identified all consecutive biopsy‐proven LN patients in our institution and compared the clinical features and lupus biomarkers between Aboriginal and Torres Strait Islander Australians and non‐Indigenous Australians. Results Of the 33 consecutive biopsy‐proven LN patients, 26 self‐identified as of Aboriginal and Torres Strait Islander descent. The estimated incidence of LN in Aboriginal and Torres Strait Islander Australian and non‐Indigenous Australians were 5.08 and 0.47 per 100 000 patient‐years respectively. Neurological manifestations (23.08% vs 0%), haematological manifestations (46.50% vs 16.67) and right‐heart catheter proven pulmonary arterial hypertension (23.08% vs 0%) were more frequently observed among Indigenous Australian patients compared with non‐Indigenous Australian patients. The incidence of positive extractable nuclear antigen was also higher among Indigenous Australian patients (84.62% vs 57.14%). Conclusion The present study further supports the observation that lupus in Aboriginal and Torres Strait Islander Australians were of a ‘distinct phenotype’ compared with non‐Indigenous Australians. Future research should be aimed at delineating the reason for this observed difference.

Aim Royal Darwin Hospital (RDH) is the main tertiary hospital that has performed more than 600 biopsies since its establishment. Although Indigenous people in Australia’s Northern Territory (NT) has the highest rate of renal replacement therapy, the histopathology pattern of their renal diseases is still under discussed. We aimed to analyse the histopathology pattern of patients undergoing renal biopsy in RDH from June 2007 to June 2020. Secondary aims include clinical indication and survival analysis of patients with kidney biopsies. Methods We conducted a retrospective cohort study on all native kidney biopsy reports from patients over the age of 16, from June 2007 to June 2020. Descriptive statistics was used to summarise age, sex, indigeneity, histopathological pattern, and mortality. Categorical values were expressed as absolute frequencies and percentages. Survival analysis was performed using multivariate analyses and Cox proportional hazard regression model. Results There were 364 native renal biopsies included in the analysis. Sub-nephrotic proteinuria was the most common clinical indication for kidney biopsy (n = 160,47.8%). Diabetes nephropathy (DN) was the most common pathological finding (n = 71,12.8%). Indigenous population who had dialysis performs poorly compared to their non-indigenous counterpart (HR 2.37,95% CI 1.53–3.67,p < 0.001). Conclusion Diabetic nephropathy is the most common native kidney biopsy in the NT with higher mortality among indigenous patients. This study supports the previous findings of indigenous female excess, younger age of kidney disease requiring kidney biopsy, and excess of diabetic nephropathy in the top-end of the NT. It can be speculated that some diabetic patients had atypical features prompting a biopsy.

In-center hemodialysis (HD) is the most common treatment for patients with end-stage renal disease (ESRD). This treatment is highly demanding and associated with complications (e.g. hypotension crises, cardiac disease) that increase patients' dependence on family members. For older patients, adult children generally assume the role of the primary caregiver. However, caring for a parent with ESRD is a stressful experience due to the several requirements that this disease entails such as fluid and diet restrictions, vascular access care, and polypharmacy protocols. Also, adult children have their responsibilities to manage, namely their marital relationships, young children, and jobs. However, to date and to the best of our knowledge, the unmet needs of adult children caring for parents undergoing in-center HD have never been explored.This study aims to explore the unmet needs of adult children caring for their parents with ESRD undergoing in-center HD. Methods: A qualitative exploratory study was conducted with a purposive sample. Semi-structured face-to-face interviews were conducted with 19 adults (44.9 AE 11.7 years old) caring for their parents undergoing in-center HD for an average of 39.8 (AE 36.4) months. The interviews were digitally audio-recorded, transcribed verbatim, and submitted to content analysis by two independent researchers. Results: Six unmet needs were identified: i) lack of support and recognition of the caregiver role from other family members (n=9); ii) lack of sufficient information about nutritional restrictions (the need for written information delivered directly to the caregiver and how to develop creative meals; n=6); iii) need of first aid assistance skills (to deal with hypotension crises and hemorrhages at home; n=5); iv) need of psychological support (to help face caregiving burden and to help the patient cope with ESRD; n=5); v) improve communication skills (learn how to communicate with a difficult patient/parent and improve communication with health professionals; n=3); and vi) social and financial support (to face disease' expenses with meal preparation and transport to dialysis; n=3). Conclusions: Adult children caring for a parent with ESRD have identified a multitude of unmet emotional, relational, and educational needs. The dialysis team can play an important role in mitigating those needs, by developing multidisciplinary interventions combining an educational and a supportive component. These interventions should focus on maximizing disease management skills while providing emotional support and facilitating communication with the healthcare renal team.