Chronic Kidney disease ... (CKD)

.. in the Australian indigenous population.

Gratuitous quotations from publications ...

MJA "Streptococcal skin infection may have a major role in the epidemic of chronic renal disease among Indigenous Australians."

UpToDate "Although PSGN continues to be the most common cause of acute nephritis globally, it primarily occurs in developing countries. Of the estimated 470,000 new annual cases of PSGN worldwide, 97 percent occur in developing countries, with an annual incidence that ranges from 9.5 to 28.5 per 100,000 individuals"

** (me commenting) ** The incidence in our indigenous community competes with "developing world" figures. The incidence of chronic kidney disease in our indigenous communities is also up to 20 times greater than the non-indigenous population with a ten fold increase in death rate from CKD. If a large proportion of CKD is in fact related to post streptococcal glomerulo-nephritis (PSGN) and PSGN is a mostly preventable disease then this is a critical public health issue.

** The increased rate of diabetes is also a significant contributor to the incidence of CKD.

HealthInfoNet

"High rates of ESRD (end stage renal disease) among Indigenous people reflect the operation of multiple risk factors. The full spectrum of risk factors has yet to be identified, but known risk factors include: increasing age, low birthweight and infant malnutrition, adult weight gain and the signs of Syndrome X (increasing blood pressure, insulin, blood glucose and lipid levels), skin infections, post-streptococcal glomerulonephritis, heavy drinking, repeated pregnancies and a family history of renal disease "

"Research highlights the broader socioeconomic determinants that underlie the physiological risk factors associated with current levels of Indigenous renal disease. The socioeconomic dimensions of the epidemic considered to be at the root of burgeoning rates of ESRD include:

. overcrowded and substandard housing;
. relatively poor nutrition;
. reduced activity levels;
. high levels of tobacco and alcohol consumption; and
. community and cultural disruptions.

These factors have social origins related to absolute poverty, relative deprivation, unemployment, homelessness and fractured kinships since the time of colonisation."

"The poor social and economic circumstances that underlie the generally lower health status of many Indigenous people contribute to the high rates of kidney and urinary tract disorders in many Indigenous communities. Prevention, control and management of kidney and urinary tract disorders will depend not only on effective, acceptable treatment, but also on preventive action to address the poor socioeconomic conditions that underlie these conditions"

** .. address the poor socioeconomic conditions ..

** This is the challenge. I don't have an answer, but I am fairly sure that the last two centuries have not provided a solution.