Post-streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life.
Although unusual in western countries and in Australia in general, post-streptococcal glomerulonephritis (PSGN) is still common in Australian Aboriginal children living in remote communities. Here, we evaluated whether episodes of acute PSGN increased the risk for chronic kidney disease in later life in 1519 residents of a remote Aboriginal community (85% of those age eligible), with high rates of renal and cardiovascular disease, who participated in a health screen over a 3-year period. Of these, 200 had had at least one episode of PSGN, with 27 having had multiple episodes, usually in childhood. High levels of albuminuria (albumin/creatinine ratio) with increasing age were confirmed. All PSGN episodes were associated with group A streptococcal skin infections, often related to scabies. In both genders, aged 10-39 years at screening, about one in five had such a history. Among them, PSGN (5 years or more earlier) was significantly associated with higher levels of albuminuria than those without. In women, aged 30-39 years, a history of PSGN was associated with a significantly higher frequency of estimated glomerular filtration rates <60 ml/min. The adjusted odds ratios for an albumin/creatinine ratio over 34 g/mol (overt albuminuria) in males and females with a history of PSGN were 4.6 and 3.1, respectively, compared with those without a history. Thus, PSGN contributes to the very serious burden of chronic kidney disease in this community. Rigorous strategies to prevent scabies and Group A streptococcal infections will reduce this burden.
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia. Electronic address: w.hoy@uq.edu.au.
Wendy E
WE
Hoy
Department of Pediatrics, James Cook University, Townsville, Queensland, Australia.
Andrew V
AV
White
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia.
Alison
A
Dowling
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia.
Suresh K
SK
Sharma
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia.
Hilary
H
Bloomfield
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia; Tiwi Community, Nguiu, Bathurst Island (NT), Australia.
Bernard T
BT
Tipiloura
Centre for Chronic Disease, University of Queensland, Herston, Queensland, Australia.
Cheryl E
CE
Swanson
The Menzies Foundation and the University of Melbourne, Melbourne, Victoria, Australia.
John D
JD
Mathews
Royal Children's Hospital, Melbourne, University of Melbourne, Melbourne, Victoria, Australia.
David A
DA
McCredie
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000419:Albuminuria / Q000453:epidemiology; D001315:Australia; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000175:diagnosis / Q000208:ethnology*; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000208:ethnology*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D012532:Scabies / Q000175:diagnosis / Q000208:ethnology*; D017678:Sex Distribution; D012737:Sex Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000208:ethnology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000208:ethnology*; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D003404:Creatinine