[The quality of the treatment of diabetics in kidney failure in Germany]

Acute kidney injury in a patient with melanuria, diffuse melanosis, and metastatic malignant melanoma

Diffuse melanosis with melanuria is a rare complication of metastatic malignant melanoma that is associated with a very poor prognosis. Acute kidney injury secondary to melanuria has not been reported previously. We describe a patient with malignant melanoma, diffuse melanosis, and melanuria who developed acute kidney injury that was clinically indicated by an increase in urinary excreted metabolites in the serum. Histopathologic examination of kidney tissue revealed damage to tubules associated with disseminated intra-tubular melanin deposits. Diffuse melanosis with melanuria may lead to morphologic and functional kidney changes and warrants careful monitoring of kidney function in affected malignant melanoma patients.

Exploring the Differences in Epidemiology of Treated ESRD Between Germany and England and Wales

BACKGROUND

The aim of this study is to investigate reasons for the large reported differences in renal replacement therapy (RRT) incidence between Germany and England and Wales (E&W).

METHODS

Age- and sex-standardized incidence rates were calculated at day 0, day 90, and day 180 by using registry data, and early RRT mortality was studied as an indicator of ascertainment differences. Nationally representative health survey data were analyzed to provide general population prevalence data for major chronic kidney disease risk factors: hypertension, diabetes, vascular disease, obesity, and smoking. Resource data were collected from routine sources and national surveys, and literature searches were performed to explore variation in chronic kidney disease prevalence, late referral, early start, and nondialytic therapy.

RESULTS

The gap in RRT incidence between Germany and E&W increased after adjusting for differences in early mortality. The standardized day-90 incidence rate ratio was 1.79 (193.0 per million of the adult population [pmap] in Germany and 107.5 pmap in E&W) diabetes and vascular disease explained 79% of this difference. Diabetes, ischemic heart disease, and hypertension were 1.85-, 1.24-, and 1.18-fold more prevalent in Germany, whereas rates of hypertension control were 0.54-fold lower (20% versus 37% in England). Ischemic heart disease mortality rates were lower in Germany.

CONCLUSION

Much of the difference in RRT incidence between Germany and E&W is explained by a greater prevalence of diabetes, hypertension, and vascular disease in the German general population, particularly those older than 65 years, and lower competing mortality risk.