title: Analysis of clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in adult indigenous people of the Northern Territory of Australia.
abstract: OBJECTIVE
  Acute postinfectious glomerulonephritis is common in indigenous communities in the Northern Territory, Australia. It is a major risk factor for the high prevalence of chronic kidney disease. We aimed to analyse the clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in the Northern Territory.
  
  
  METHODS
  We performed a retrospective cohort analysis of all adult patients (≥18 years) who were diagnosed with acute postinfectious glomerulonephritis on native renal biopsies from 01/01/2004 to 31/05/2014. The outcome measure was end-stage renal disease requiring long-term dialysis.
  
  
  RESULTS
  Forty-three of 340 patients who had renal biopsies had acute postinfectious glomerulonephritis. Most were Aboriginals (88.4%). They had co-morbidities; diabetes mellitus (60.5%), hypertension (60.5%) and smoking (56.4%). Forty-nine per cent had multiple pathologies on biopsy. Predominant histological pattern was diffuse proliferative glomerulonephritis (72%). Main sites of infections were skin (47.6%) and upper respiratory tract infection (26.2%) with streptococcus and staphylococcus as predominant organisms. Fifty per cent of patients developed end-stage renal disease. On multivariable logistic regression analysis, those on dialysis had higher baseline creatinine (P = 0.003), higher albumin/creatinine ratio at presentation (P = 0.023), higher serum creatinine at presentation (P = 0.02) and lower estimated glomerular filtration rate at presentation (P = 0.012).
  
  
  CONCLUSIONS
  Overall, most patients had pre-existing pathology with superimposed acute postinfectious glomerulonephritis that led to poor outcomes in our cohort.
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.|Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Ramanathan
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
authors.forename: Asanga
authors.initials: A
authors.lastname: Abeyaratne
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
authors.forename: Madhivanan
authors.initials: M
authors.lastname: Sundaram
authors.affiliation: Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
authors.forename: David Kiran
authors.initials: DK
authors.lastname: Fernandes
authors.affiliation: Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
authors.forename: Basant
authors.initials: B
authors.lastname: Pawar
authors.affiliation: Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Greg John
authors.initials: GJ
authors.lastname: Perry
authors.affiliation: Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.|Northern Territory Medical Programme, School of Medicine, Flinders University, Darwin, Northern Territory, Australia.
authors.forename: Cherian
authors.initials: C
authors.lastname: Sajiv
authors.affiliation: Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.|Northern Territory Medical Programme, School of Medicine, Flinders University, Darwin, Northern Territory, Australia.
authors.forename: Sandawana William
authors.initials: SW
authors.lastname: Majoni
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D003141:Communicable Diseases / Q000175:diagnosis / Q000208:ethnology*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000208:ethnology* / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aborigines; Australia; end-stage renal failure; glomerulonephritis; infection