The epidemiology of renal disease in Aboriginal Australians

Abstract

Data from dialysis units in the Northern Territory and, from a rural community screening program in South Australia, suggested there was a high prevalence of renal disease in Aboriginal Australians. This thesis documents the high prevalence of urinary abnormalities in three Aboriginal communities in the Northern Territory and examines factors of aetiological relevance.

After ethical approval from the local institutional ethics committee which has Aboriginal

representation, a randomly chosen group of 327 adults and 180 children consented to participate in pilot studies in three communities. Subsequently a family-based study of 16 families comprising all 219 persons over the age of 10 years was undertaken in the community with the highest prevalence of renal disease.

Subjects with renal disease were identified on the basis of a urinary protein to creatinine ratio of > 50 mg/mmol; this measure was shown to be reproducible; urine was also examined by microscopy and culture. Anthropometric and blood pressure measurements were made under standard conditions. Biochemical parameters were assayed on a sample of blood collected 2 hours after a 75g glucose load (in adults) or at the time of collection of throat and skin swabs for streptococcal surveillance (in children).

In the community with the highest frequency of renal disease, some of the renal disease was not associated with diabetes, but was familial and associated with glomerular haematuria; in this same community glomerular haematuria and significant proteinuria were seen also in children. In all three communities, renal disease was associated with obesity, diabetes mellitus and hypertension. In none of the communities was renal disease associated with HBsAG, or evidence of hepatic disease. Although urinary tract infection was detected in some subjects with diabetes, it was not frequent enough to account for the high prevalence of renal disease in diabetics, nor for the high prevalence of renal disease in the Aboriginal communities studied.