The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community

Abstract

Renal disease in this population is multifactorial, with risk factors related to whole-of-life nutrition, metabolic and hemodynamic profiles, infections, health behaviors, and possibly a family predisposition. Its relationship to low birth weight, and its associations with deteriorating metabolic and hemodynamic profiles, suggest that renal disease is, in part, a component of Syndrome X, which explains the simultaneous increase in metabolic, cardiovascular and renal disease in Aboriginal people. The family clustering might have both environmental and genetic causes, and is under further investigation. Most of the identified risk factors arise out of poverty, disadvantage and accelerated lifestyle change, and the current epidemic can be explained by the confluence of many risk factors in the last few decades. The introduction of effective and sustained programs to address social, economic and educational inequities in all Aboriginal communities, and of screening and renal- and cardiovascular-protective treatment programs for those already afflicted are matters of great urgency.

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

“…24 Given albuminuria is a marker of early chronic kidney disease, this suggests that APSGN may be contributing to the extremely high rates of chronic renal failure seen in Indigenous Australian adults. 25 The incidence rates in this study included only notified confirmed cases. Case ascertainment and reporting is likely to be incomplete.…”

The Clinical Importance of Nephron Mass

“…15,71,[113][114][115][116][117] The earliest evidence from Australian Aboriginals found an odds ratio of 2.8 for macroalbuminuria in those who had been of LBW compared with NBW. 15,71,113,114 In addition, the degree of albuminuria predicted loss of renal function and strongly correlated with mortality. 71,72 Similarly, among Pima Indians with type 2 diabetes, the prevalence of albuminuria was higher in those who had birth weights Ͻ2500 or Ͼ4500 g compared with those of NBW.…”

Albuminuria in Australian Aboriginal people: prevalence and associations with components of the metabolic syndrome

“…Diabetes and hypertension strongly predict the presence of albuminuria in several population studies [10±14]. Some studies have indicated that abdominal obesity, insulin resistance and dyslipidaemia are also independently associated with albuminuria [2,11,14].…”