| Abstract: | Background: An epidemic of end‐stage renal disease is occurring in Aboriginal people. Post streptococcal glomerulonephritis (PSGN) associated with pyoderma, occurs frequently in Aboriginal children, although it is virtually eliminated in the rest of Australia. We examined the association between PSGN in childhood and the development of chronic renal disease in later life. Methods: In a remote coastal community in the Northern Territory, we established a historical cohort of children who were aged 2‐15 years during epidemic PSGN in 1980 and 1987. History of PSGN during the epidemics was defined using clinical criteria from the original medical records. a) PSGN: haematuria/proteinuria plus oedema or hypertension n = 63 b) haematuria or proteinuria only n = 87, and c) controls: normal examination and urinalysis n = 89, or normal examination without urinalysis n = 135 or not seen n = 98. The main outcome measure, urine albumin to creatinine ratio ACR, was measured in these people at a mean time of 14 years after the epidemics and at a mean age of 20 yrs, range 8‐33. Results: Proportions with albuminuria at follow‐up. | All
n = 472 | Controls
n = 322 | Haem/prot
n = 87< | PSGN
n = 63 | | ACR ≥ 3.4 | 22% | 18% | 31% | 32% | | ACR ≥ 34 | 6% | 4% | 8% | 13% | The relative risk (RR) for overt albuminuria (ACR ≥ 34) in those with a remote episode of PSGN compared to controls is 4.2 (95% CI 1.9‐9), after adjustment for age and sex, and the population attributable risk (PAR) is 32% (90% CI 11‐49). The RR of microalbuminuria (ACR ≥ 3.4) is 2.1 (95% CI 1.4‐3.1) and the PAR 14% (90% CI 6‐22). There were no differences in blood pressure, creatinine or calculated GFR. Conclusion: In this population, PSGN in childhood is a powerful risk factor for the development of albuminuria in early adult life. |
