Megill D M, Hoy W E, Woodruff S D
West J Med. 1988 Aug;149(2):178-82.
The rates of end-stage renal disease are much increased in American Indians, but no longitudinal study of its rates and causes has been undertaken in any tribe. This 15-year study of rates and causes of treated end-stage renal disease in the Navajo, the largest Indian tribe, supplies an important model on which to base projections and plan interventions. Treated end-stage renal disease in Navajos has increased to an age-adjusted incidence 4 times that in whites in the United States. Diabetic nephropathy accounted for 50% of all new cases in 1985, with an incidence 9.6 times that in US whites, and was due entirely to type II disease. Glomerulonephritis caused end-stage renal disease in Navajos at a rate at least 1.8 times that in US whites and afflicted a much younger population. The predominant form was mesangial proliferative glomerulonephritis associated with an immune complex deposition. Renal disease of unknown etiology, which probably includes much silent glomerulonephritis, accounted for 20% of all new cases. The aggregate Navajo population with end-stage renal disease was 9 years younger than its US counterpart. These observations reflect the genesis of the epidemic of diabetic nephropathy afflicting many tribes. Urgent measures are needed to contain this. In addition, the etiology and control of mesangiopathic, immune-complex glomerulonephritis of unusual severity, a previously unrecognized problem, need to be addressed.
美国印第安人中终末期肾病的发病率大幅上升，但尚未对任何部落的发病率及其病因进行纵向研究。这项针对最大的印第安部落纳瓦霍人治疗终末期肾病的发病率及其病因的15年研究，提供了一个重要的模型，可用于进行预测和规划干预措施。纳瓦霍人治疗终末期肾病的年龄调整发病率已升至美国白人的4倍。1985年，糖尿病肾病占所有新发病例的50%，其发病率是美国白人的9.6倍，且完全由II型疾病引起。肾小球肾炎导致纳瓦霍人终末期肾病的发病率至少是美国白人的1.8倍，且患者群体更为年轻。主要形式是与免疫复合物沉积相关的系膜增生性肾小球肾炎。病因不明的肾病（可能包括许多隐匿性肾小球肾炎）占所有新发病例的20%。患有终末期肾病的纳瓦霍人总人口比美国白人的相应群体年轻9岁。这些观察结果反映了困扰许多部落的糖尿病肾病流行的起源。需要采取紧急措施来控制这一情况。此外，还需要解决一种以前未被认识到的问题，即异常严重的系膜性免疫复合物肾小球肾炎的病因及控制。
