Van Buynder P G, Gaggin J A, Mathews J D
Menzies School of Health Research, Casuarina, NT.
Med J Aust. 1993 Jul 19;159(2):82-7.
To explore the apparent excess of renal disease in a coastal Aboriginal community in the Northern Territory and to explore its familial basis.
Families were ascertained through probands with significant proteinuria. Controls were selected from unrelated subjects living with these families.
All surviving grandparents, parents, siblings, children and grandchildren of 16 probands were studied; there were 219 participants in all, including 58 adult control subjects.
Anthropometric data included the body mass index (BMI), and resting blood pressure. Urinary protein and creatinine levels were measured and urine was examined microscopically for glomerular haematuria (more than 10 red blood cells per microL, with at least 20% dysmorphic red cells). Two hours after a 75 g glucose drink, venous blood was taken and analysed for biochemical markers including urea, creatinine, glucose and gamma-glutamyltransferase.
Significant proteinuria (protein to creatinine ratio greater than 50 mg/mmol), provided evidence of renal disease in 30% of both case relatives and control subjects. The prevalence of proteinuria was associated with increasing age, increasing diastolic blood pressure, increasing glucose level and female sex. However, two contrasting groups of subjects were identified in that relatives of probands had more glomerular haematuria than controls (27/112 v. 3/58, P = 0.005) and this was most marked in a family with multiple probands and in the parents of probands; in contrast, controls were more likely to have hypertension and obesity. Diabetes was highly prevalent in adult study subjects (12.4%) with no difference between controls and relatives of probands.
The very high prevalence of renal disease in Australian Aborigines parallels the situation in American Indian communities undergoing rapid cultural change. In the island Aboriginal community studied, proteinuria and glomerular haematuria are familial, possibly due to genetically influenced glomerulonephritis evoked by (unknown) environmental factors. Proteinuria associated with obesity, hypertension and diabetes is less obviously familial, and plausibly related to poor nutrition and other lifestyle factors. The high prevalence of proteinuria and other risk factors in community-based studies and the high incidence of end-stage renal disease show that there is an urgent need for effective education and prevention programs, for more active treatment of hypertension, and for further work to clarify the aetiology and pathogenesis of renal disease in Aboriginal communities.
探究北领地一个沿海原住民社区中肾病明显过多的情况，并探究其家族性基础。
通过患有显著蛋白尿的先证者确定家族。对照从与这些家族共同生活的无亲属关系个体中选取。
对16名先证者的所有在世祖父母、父母、兄弟姐妹、子女和孙子女进行了研究；共有219名参与者，包括58名成年对照对象。
人体测量数据包括体重指数（BMI）和静息血压。测量尿蛋白和肌酐水平，并对尿液进行显微镜检查以检测肾小球性血尿（每微升超过10个红细胞，其中至少20%为异形红细胞）。在饮用75克葡萄糖饮料两小时后，采集静脉血并分析生化指标，包括尿素、肌酐、葡萄糖和γ-谷氨酰转移酶。
显著蛋白尿（蛋白与肌酐比值大于50毫克/毫摩尔）在30%的病例亲属和对照对象中都提示存在肾病。蛋白尿患病率与年龄增加、舒张压升高、血糖水平升高以及女性性别相关。然而，确定了两组形成对比的对象，即先证者的亲属比对照对象有更多的肾小球性血尿（27/112对3/58，P = 0.005），这在有多个先证者的家族以及先证者的父母中最为明显；相反，对照对象更易患高血压和肥胖症。糖尿病在成年研究对象中高度流行（12.4%），对照对象和先证者的亲属之间无差异。
澳大利亚原住民中肾病的极高患病率与经历快速文化变迁的美国印第安社区的情况相似。在所研究的岛屿原住民社区中，蛋白尿和肾小球性血尿具有家族性，可能是由于（未知的）环境因素诱发的受遗传影响的肾小球肾炎所致。与肥胖、高血压和糖尿病相关的蛋白尿家族性不太明显，可能与营养不良和其他生活方式因素有关。基于社区的研究中蛋白尿和其他危险因素的高患病率以及终末期肾病的高发病率表明，迫切需要有效的教育和预防项目，更积极地治疗高血压，并进一步开展工作以阐明原住民社区肾病的病因和发病机制。
