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. Issue 5 (May 2017)

• Record Type: Journal Article
• Authors: Ramanathan, Ganesh; Abeyaratne, Asanga; Sundaram, Madhivanan; Fernandes, David Kiran; Pawar, Basant; Perry, Greg John; Sajiv, Cherian; Majoni, Sandawana William
• Is Part Of: Nephrology. Volume 22:Issue 5(2017)
• Page Start: 403
• Page End: 411
• Publication Date: 2017-05
• Subjects: Aborigines -- Australia -- end‐stage renal failure -- glomerulonephritis -- infection; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.12797
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: 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). Conclusion: Overall, most patients had pre‐existing pathology with superimposed acute postinfectious glomerulonephritis that led to poor outcomes in our cohort. Summary At a Glance: This study showed unique findings that APIGN is associated with poor renal outcomes and requirement for long‐term dialysis in adult Indigenous Australians in the NT. Impressively, most patients had pre‐existing pathology with superimposed APIGN that led to significant and permanent deterioration in kidney function.