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Drusen are retinal deposits comprising cell debris, immune material and complement that are characteristic of macular degeneration but also found in glomerulonephritis. This was a pilot cross-sectional study to determine how often drusen occurred in IgA glomerulonephritis and their clinical significance. Study participants underwent non-mydriatic retinal photography, and their deidentified retinal images were examined for drusen by two trained graders, who compared central drusen counts, counts ≥ 10 and drusen size with those of matched controls. The cohort comprised 122 individuals with IgA glomerulonephritis including 89 males (73%), 49 individuals (40%) of East Asian or Southern European ancestry, with an overall median age of 54 years (34–64), and median disease duration of 9 years (4–17). Thirty-nine (33%) had an eGFR < 60 ml/min/1.73 m 2 and 72 had previously reached kidney failure (61%). Overall mean drusen counts were higher in IgA glomerulonephritis (9 ± 27) than controls (2 ± 7, p  < 0.001). Central counts ≥ 10 were also more common (OR = 3.31 (1.42–7.73, p  = 0.006), and were associated with longer disease duration ( p  = 0.03) but not kidney failure ( p  = 0.31). Larger drusen were associated with more mesangial IgA staining ( p  = 0.004). Increased drusen counts were also present in IgA glomerulonephritis secondary to Crohn’s disease but not with Henoch-Schonlein purpura. The finding of retinal drusen in IgA glomerulonephritis is consistent with complement activation and represents a model for better understanding glomerular immune deposition and a supporting argument for treatment with anti-complement therapies.

Background Keloids are rare but challenging complications in penile surgeries, including circumcision. The President’s Emergency Plan for AIDS Relief (PEPFAR) supports voluntary medical male circumcisions (VMMC) for HIV prevention in sub-Saharan Africa, and has monitored major adverse events through its Notifiable Adverse Event Reporting system (NAER) since 2015, providing unique opportunities to understand keloid epidemiology and risk factors. Methods All 2015–2023 NAER keloid cases were reviewed. Variables abstracted included age at VMMC, time course, and case characteristics. Descriptive analysis and Fisher’s exact test of the association between client age (< 15 years vs. ≥ 15 years) and keloids were performed. Systematic literature searches were also conducted on case reports, outcomes and management guidelines, to produce a narrative summary and comparisons between the NAER cases and prior literature. Results Eleven cases were reported. Clients were < 15 years old in 10/11, with median age 12 years and mean time to diagnosis 1.8 years. Clients aged 10–14 years had a significantly higher risk for keloids compared to those aged 15 and older ( p  = 0.0004). Case characteristics were similar to those in prior case series, as was management, except that silicone gels or sheeting were not used. Follow-up was too brief to assess outcomes. Conclusions Keloids were a rare complication of PEPFAR-supported VMMCs. Keloids were strongly associated with age 10–14 years at circumcision as compared to older age. Programs can remind clients to return to VMMC sites even for late complications, and develop expert referral networks. Silicone gels or sheeting could represent an additional conservative management option.