Kidney disease in Aboriginal Australians: a perspective from the Northern Territory

Abstract

This article outlines the increasing awareness, service development and research in renal disease in Aboriginal people in Australia's Northern Territory, among whom the rates of renal replacement therapy (RRT) are among the highest in the world. Kidney failure and RRT dominate the intellectual landscape and consume the most professional energy, but the underlying kidney disease has recently swung into view, with increasing awareness of its connection to other chronic diseases and to health profiles and trajectories more broadly. Albuminuria is the marker of the underlying kidney disease and the best treatment target, and glomerulomegaly and focal glomerulosclerosis are the defining histologic features. Risk factors in its multideterminant genesis reflect nutritional and developmental disadvantage and inflammatory/infectious milieu, while the major putative genetic determinants still elude detection. A culture shift of “chronic disease prevention” has been catalyzed in part by the human pain, logistic problems and great costs associated with RRT. Nowadays chronic disease management is the central focus of indigenous primary care, with defined protocols for integrated testing and management of chronic diseases and with government reimbursed service items and free medicines for people in remote areas. Blood pressure, cardiovascular risk and chronic kidney disease (CKD) are all mitigated by good treatment, which centres on renin-angiotensin system blockade and good metabolic control. RRT incidence rates appear to be stabilizing in remote Aboriginal people, and chronic disease deaths rates are falling. However, the profound levels of disadvantage in many remote settings remain appalling, and there is still much to be done, mostly beyond the direct reach of health services.

An expanded nationwide view of chronic kidney disease in Aboriginal Australians

“…B), which reflects in large part the proportions of their indigenous populations who live remotely . A recent review of RRT in the Northern Territory summarizes some of the challenges faced by Aboriginal patients and health systems in remote areas of Australia …”

Renal histology in Indigenous Australians with lupus nephritis

“…17 An alternative explanation for the observed lower renal inflammatory burden could be the shorter interval between disease onset and renal biopsy in the IA patients. As nephritogenic anti-dsDNA antibodies arise through a process of affinity maturation over time, 20 clinician concern over the overall renal vulnerability in IA for hypertensive and metabolic complications 21 may have led to diagnostic intervention too early to capture full-blown LN and led to under treatment. However, the relatively low rate of class transformation and disease progression on repeat biopsies with no obvious difference between IA and NI patients would argue against this consideration, while expert opinion also recommends early renal biopsy in the face of urinary abnormalities.…”

Kidneys and women's health: key challenges and considerations

“…This impact is best illustrated by the example of the Tiwi Islanders -prior to the introduction of public health measures aimed at improving maternal health, nearly all children were born with reduced nephron numbers, which were associated with early onset of albuminuria, progressive CKD, hypertension and multiple other health risks 25 . The contribution of the adverse consequences of fetal growth restriction to the global epidemic of chronic non-communicable diseases mandates ensuring that all women, but particularly those with impaired kidney function, have safe and well-managed pregnancies to minimize fetal risks.…”