Renal biopsy findings among Indigenous Australians: a nationwide review

Hoy, Wendy E., Samuel, Terence, Mott, Susan A., Kincaid-Smith, Priscilla S., Fogo, Agnes B., Dowling, John P., Hughson, Michael D., Sinniah, Rajalingam, Pugsley, David J., Kirubakaran, Meshach G., Douglas-Denton, Rebecca N. and Bertram, John F. (2012) Renal biopsy findings among Indigenous Australians: a nationwide review. Kidney International, 82 12: 1321-1331. doi:10.1038/ki.2012.307

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Author Hoy, Wendy E.
Samuel, Terence
Mott, Susan A.
Kincaid-Smith, Priscilla S.
Fogo, Agnes B.
Dowling, John P.
Hughson, Michael D.
Sinniah, Rajalingam
Pugsley, David J.
Kirubakaran, Meshach G.
Douglas-Denton, Rebecca N.
Bertram, John F.
Title Renal biopsy findings among Indigenous Australians: a nationwide review
Journal name Kidney International   Check publisher's open access policy
ISSN 0085-2538
Publication date 2012-12-02
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1038/ki.2012.307
Open Access Status File (Author Post-print)
Volume 82
Issue 12
Start page 1321
End page 1331
Total pages 11
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Collection year 2013
Language eng
Abstract Australia's Indigenous people have high rates of chronic kidney disease and kidney failure. To define renal disease among these people, we reviewed 643 renal biopsies on Indigenous people across Australia, and compared them with 249 biopsies of non-Indigenous patients. The intent was to reach a consensus on pathological findings and terminology, quantify glomerular size, and establish and compare regional biopsy profiles. The relative population-adjusted biopsy frequencies were 16.9, 6.6, and 1, respectively, for Aboriginal people living remotely/very remotely, for Torres Strait Islander people, and for non-remote-living Aboriginal people. Indigenous people more often had heavy proteinuria and renal failure at biopsy. No single condition defined the Indigenous biopsies and, where biopsy rates were high, all common conditions were in absolute excess. Indigenous people were more often diabetic than non-Indigenous people, but diabetic changes were still present in fewer than half their biopsies. Their biopsies also had higher rates of segmental sclerosis, post-infectious glomerulonephritis, and mixed morphologies. Among the great excess of biopsies in remote/very remote Aborigines, females predominated, with younger age at biopsy and larger mean glomerular volumes. Glomerulomegaly characterized biopsies with mesangiopathic changes only, with IgA deposition, or with diabetic change, and with focal segmental glomerulosclerosis (FSGS). This review reveals great variations in biopsy rates and findings among Indigenous Australians, and findings refute the prevailing dogma that most indigenous renal disease is due to diabetes. Glomerulomegaly in remote/very remote Aboriginal people is probably due to nephron deficiency, in part related to low birth weight, and probably contributes to the increased susceptibility to kidney disease and the predisposition to FSGS.
Keyword Aborigines
Indigenous Australians
Kidney biopsies
Systematic review
Torres Strait Islanders
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 27 times in Thomson Reuters Web of Science Article | Citations
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