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1.
J Paediatr Child Health ; 59(5): 735-742, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36975716

RESUMEN

AIMS: Despite the declining incidence of acute post-streptococcal glomerulonephritis (APSGN) in Australia, there is still a significant burden of disease amongst Aboriginal and Torres Strait Islander people in the Northern Territory. Childhood APSGN has been highlighted as a predictor of chronic kidney disease in this population. We aimed to describe clinical characteristics and outcomes of hospitalised children with APSGN in the Northern Territory. METHODS: Single-centre, retrospective cohort study of children (<18 years) with APSGN admitted to a tertiary hospital in the Top End of the Northern Territory between January 2012 and December 2017. Cases were confirmed using the Centre for Disease Control case definition guidelines. Data were extracted from the case notes and electronic medical records. RESULTS: There were 96 cases of APSGN with median age of 7.1 years (interquartile range (IQR) 6.7-11.4). Majority were Aboriginal and Torres Strait Islander (90.6%) and from rural and remote areas (82.3%). Preceding skin infections were identified in 65.5% and sore throat in 27.1%. Severe complications included hypertensive emergencies (37.4%), acute kidney injury (43.8%) and nephrotic-range proteinuria (57.7%). All children improved from their acute illness with supportive medical therapy; however, only 55 out of 96 (57.3%) children were followed up within 12 months of their acute illness. CONCLUSIONS: APSGN disproportionately affects Aboriginal and Torres Strait Islander children and highlights the need for continued and improved public health response. There is room for significant improvement in the medium- and long-term follow-up of affected children.


Asunto(s)
Aborigenas Australianos e Isleños del Estrecho de Torres , Glomerulonefritis , Infecciones Estreptocócicas , Niño , Humanos , Enfermedad Aguda , Aborigenas Australianos e Isleños del Estrecho de Torres/estadística & datos numéricos , Niño Hospitalizado/estadística & datos numéricos , Glomerulonefritis/epidemiología , Glomerulonefritis/etnología , Glomerulonefritis/etiología , Northern Territory/epidemiología , Estudios Retrospectivos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/etnología , Costo de Enfermedad
2.
J Am Soc Nephrol ; 30(12): 2437-2448, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31554657

RESUMEN

BACKGROUND: Pregnancy in women with ESKD undergoing dialysis is uncommon due to impaired fertility. Data on pregnancy in women on dialysis in the United States is scarce. METHODS: We evaluated a retrospective cohort of 47,555 women aged 15-44 years on dialysis between January 1, 2005 and December 31, 2013 using data from the United States Renal Data System with Medicare as primary payer. We calculated pregnancy rates and identified factors associated with pregnancy. RESULTS: In 47,555 women on dialysis, 2352 pregnancies were identified. Pregnancy rate was 17.8 per thousand person years (PTPY) with the highest rate in women aged 20-24 (40.9 PTPY). In the adjusted time-to-event analysis, a higher likelihood of pregnancy was seen in Native American (HR, 1.77; 95% CI, 1.33 to 2.36), Hispanic (HR, 1.51; 95% CI, 1.32 to 1.73), and black (HR, 1.33; 95% CI, 1.18 to 1.49) women than in white women. A higher rate of pregnancy was seen in women with ESKD due to malignancy (HR, 1.64; 95% CI, 1.27 to 2.12), GN (HR, 1.38; 95% CI, 1.21 to 1.58), hypertension (HR, 1.32; 95% CI, 1.16 to 1.51), and secondary GN/vasculitis (HR, 1.18; 95% CI, 1.02 to 1.37) than ESKD due to diabetes. A lower likelihood of pregnancy was seen among women on peritoneal dialysis than on hemodialysis (HR, 0.47; 95% CI, 0.41 to 0.55). CONCLUSIONS: The pregnancy rate is higher in women on dialysis than previous reports indicate. A higher likelihood of pregnancy was associated with race/ethnicity, ESKD cause, and dialysis modality.


Asunto(s)
Fallo Renal Crónico/etnología , Complicaciones del Embarazo/etnología , Diálisis Renal , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Comorbilidad , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/etnología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/etnología , Indígenas Norteamericanos/estadística & datos numéricos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Medicare , Neoplasias/complicaciones , Neoplasias/etnología , Diálisis Peritoneal/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/terapia , Resultado del Embarazo , Índice de Embarazo , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Adulto Joven
3.
Am J Nephrol ; 45(3): 248-256, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28161700

RESUMEN

BACKGROUND: Fibrillary glomerulonephritis is characterized by randomly arranged fibrils, approximately 20 nm in diameter by electron microscopy. Patients present with proteinuria, hematuria and kidney insufficiency, and about half of the reported patients progress to end-stage kidney disease within 4 years. The dependence of patient characteristics and outcomes on race has not been explored. In this study, we describe a cohort of patients with fibrillary glomerulonephritis and compare their clinical characteristics and outcomes with those of patients previously described. METHODS: The University of North Carolina (UNC) Nephropathology Database was used to retrospectively identify patients diagnosed with fibrillary glomerulonephritis between 1985 and 2015. Of these patients, those treated at UNC were selected. Their demographic and clinical characteristics - including signs and symptoms, comorbidities, laboratory values, treatments and outcomes - were compared with those of patients described earlier. RESULTS: Among the 287 patients identified, 42 were treated at the UNC Kidney Center. When compared to earlier cohorts, a higher frequency of black race, hepatitis C virus (HCV) infection and use of hemodialysis were noted in both black and HCV-positive patients. Autoimmune diseases, infections and malignancies were frequently observed, present in over half of all cases. CONCLUSION: According to this study, fibrillary glomerulonephritis represents a secondary glomerular disease process (associated with autoimmune disease, infection or malignancy) in many cases and hence screening is essential. As the screening for comorbidities increased over time, more underlying causes were identified. We noted a high frequency of HCV among black patients, suggesting a possible causative association. Treatment of underlying disease is essential for patients for the best outcome.


Asunto(s)
Glomerulonefritis/etnología , Glomerulonefritis/terapia , Fallo Renal Crónico/etnología , Fallo Renal Crónico/terapia , Negro o Afroamericano , Anciano , Biopsia , Femenino , Glomerulonefritis/complicaciones , Humanos , Riñón/patología , Fallo Renal Crónico/complicaciones , Glomérulos Renales/patología , Masculino , Persona de Mediana Edad , North Carolina , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Universidades
4.
Nephrology (Carlton) ; 22(5): 403-411, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27062647

RESUMEN

AIM: Acute postinfectious glomerulonephritis is common in indigenous communities in the Northern Territory, Australia. It is a major risk factor for the high prevalence of chronic kidney disease. We aimed to analyse the clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in the Northern Territory. METHODS: We performed a retrospective cohort analysis of all adult patients (≥18 years) who were diagnosed with acute postinfectious glomerulonephritis on native renal biopsies from 01/01/2004 to 31/05/2014. The outcome measure was end-stage renal disease requiring long-term dialysis. RESULTS: Forty-three of 340 patients who had renal biopsies had acute postinfectious glomerulonephritis. Most were Aboriginals (88.4%). They had co-morbidities; diabetes mellitus (60.5%), hypertension (60.5%) and smoking (56.4%). Forty-nine per cent had multiple pathologies on biopsy. Predominant histological pattern was diffuse proliferative glomerulonephritis (72%). Main sites of infections were skin (47.6%) and upper respiratory tract infection (26.2%) with streptococcus and staphylococcus as predominant organisms. Fifty per cent of patients developed end-stage renal disease. On multivariable logistic regression analysis, those on dialysis had higher baseline creatinine (P = 0.003), higher albumin/creatinine ratio at presentation (P = 0.023), higher serum creatinine at presentation (P = 0.02) and lower estimated glomerular filtration rate at presentation (P = 0.012). CONCLUSION: Overall, most patients had pre-existing pathology with superimposed acute postinfectious glomerulonephritis that led to poor outcomes in our cohort.


Asunto(s)
Enfermedades Transmisibles/etnología , Glomerulonefritis/etnología , Glomerulonefritis/patología , Riñón/patología , Nativos de Hawái y Otras Islas del Pacífico , Enfermedad Aguda , Adulto , Biopsia , Enfermedades Transmisibles/diagnóstico , Comorbilidad , Progresión de la Enfermedad , Femenino , Técnica del Anticuerpo Fluorescente , Glomerulonefritis/fisiopatología , Glomerulonefritis/terapia , Humanos , Riñón/fisiopatología , Fallo Renal Crónico/etnología , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Northern Territory/epidemiología , Diálisis Renal , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
5.
Am J Nephrol ; 43(2): 112-9, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27003681

RESUMEN

BACKGROUND: As renal biopsies are not routinely repeated to monitor treatment response in anti-neutrophil cytoplasm antibody (ANCA)-associated glomerulonephritis, serum creatinine (SC) and proteinuria assessed by urine protein:creatinine ratio (UPCR) measurements are relied upon to provide a non-invasive estimate of disease activity within the kidney. However, sparse information exists about the time to achieve maximal improvement in these parameters, which has important implications for treatment decisions and disease-scoring systems. METHODS: We analysed patients with ANCA-associated glomerulonephritis and renal impairment from cohorts in the United Kingdom and Ireland, with the primary objective of determining actuarial time to nadir SC and UPCR. Time to disappearance of haematuria was analysed as a secondary objective. RESULTS: Ninety-four patients fulfilled our selection criteria, with 94 (100%) and 66 (70%) having reached their nadir SC and UPCR respectively during the follow-up period. Nadir SC was achieved after a median of 88 days (95% CI 74-102), UPCR at 346 days (95% CI 205-487). Those of Indo-Asian ethnic origin reached their nadir SC faster (34 days) than other ethnicities (p < 0.01). There were no significant differences in time to nadir SC or UPCR on the basis of gender, clinical diagnosis, ANCA positivity or renal biopsy findings. CONCLUSION: In this retrospective study, nadir creatinine and proteinuria occur later than other signs of clinical remission, suggesting that ongoing renal recovery continues for a significant time after diagnosis. It may benefit disease-scoring systems to take into account SC levels beyond the initial assessment.


Asunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Pueblo Asiatico/estadística & datos numéricos , Glomerulonefritis/fisiopatología , Recuperación de la Función , Población Blanca/estadística & datos numéricos , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Creatinina/sangre , Creatinina/orina , Femenino , Glomerulonefritis/etnología , Glomerulonefritis/etiología , Hematuria/orina , Humanos , Masculino , Proteinuria/orina , Estudios Retrospectivos , Factores de Tiempo
6.
Nephrol Dial Transplant ; 31(6): 971-7, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-25061125

RESUMEN

BACKGROUND: Australian Aborigines in remote areas have very high rates of kidney disease, which is marked by albuminuria. We describe a 'multihit' model of albuminuria in young adults in one remote Aboriginal community. METHODS: Urinary albumin/creatinine ratios (ACRs) were measured in 655 subjects aged 15-39 years and evaluated in the context of birthweights, a history of 'remote' poststreptococcal glomerulonephritis (PSGN; ≥5 years earlier) and current body mass index (BMI). Birthweight had been <2.5 kg (low birthweight, LBW) in 25.4% of subjects and 22.8% had a remote history of PSGN. RESULTS: ACR levels rose with age. It exceeded the microalbuminuria threshold in 33.6% of subjects overall (25% of males and 45% of females). In multivariate models, birthweight (inversely), remote PSGN and current BMI were all independent predictors of ACR levels. The effects of birthweight and PSGN and their combination were expressed through amplification of ACR levels in relation to age and around the group median BMI of 20.8 kg/m(2). In people with BMI <20.8 (57.8% of all males and 40.3% of the females), LBW and PSGN alone had minimal effects on ACR, but in combination they strikingly amplified ACR in relation to age. Those with BMI ≥20.8 (which included 42.2% of the males and 59.7% of the females) had higher ACR levels, and both LBW and a PSGN history, separately and in combination, were associated with striking further amplification of ACR in the context of age. CONCLUSION: Much of the great excess of disease in this population is explained by high rates of the early life risk factors, LBW and PSGN. Their effects are expressed through amplification of ACR in the context of increasing age and are further moderated by levels of current body size. Both early life risk factors are potentially modifiable.


Asunto(s)
Albuminuria/etnología , Peso al Nacer , Índice de Masa Corporal , Glomerulonefritis/complicaciones , Nativos de Hawái y Otras Islas del Pacífico , Insuficiencia Renal/complicaciones , Infecciones Estreptocócicas/complicaciones , Adolescente , Adulto , Albuminuria/diagnóstico , Albuminuria/etiología , Australia/epidemiología , Femenino , Glomerulonefritis/etnología , Humanos , Incidencia , Recién Nacido de Bajo Peso , Masculino , Insuficiencia Renal/etnología , Factores de Riesgo , Infecciones Estreptocócicas/etnología , Adulto Joven
7.
Clin Nephrol ; 83(7 Suppl 1): 75-81, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25725247

RESUMEN

BACKGROUND: Australian Aborigines in remote areas have very high rates of kidney disease, which is marked by albuminuria. We describe a "multihit" model of albuminuria in young adults in one remote Aboriginal community. METHODS: Urinary albumin/creatinine ratios (ACR) were measured in all subjects who volunteered to participate in a community-wide health screen. Subjects for this study were young adults who had birth weights recorded and whose medical records were inspected for a history of post-streptococcal glomerulonephritis (PSGN). Urine ACR levels were evaluated in the context of birth weights, PSGN history and current BMI. RESULTS: 580 subjects (335 males and 245 females) who were aged 18 - 39 years at time of screening and qualified for inclusion. 26% of subjects had birth weights of < 2.5 kg, and the median birth weight was 2.8 kg. 23% of subjects had a remote history of PSGN, all 3 or more years earlier. Median BMI for the group was 21 kg/m2. Urine ACR levels exceeded the microalbuminuria threshold of 3.4 g/mol in 35.5% of subjects. Birth weight (inversely), remote PSGN, and current BMI were all independent predictors of ACR levels. Median levels of ACR were lowest in those with birth weights ≥ 2.5 kg, and no history of PSGN, intermediate in those with either birth weights < 2.5 kg or a history of PSGN, and highest in those with both low birth weights and a PSGN history. ACR levels were higher in those with BMIs above the median values, most notably in those with lower birth weights or a PSGN history or both. INTERPRETATION: Much of the great excess of disease in this population is explained by high rates of the early life risk factors, low birth weight and PSGN. Their effects are expressed through amplification of ACR in the context of increasing age, and are further moderated by levels of current body size. Both early life risk factors are potentially modifiable.


Asunto(s)
Albuminuria/etnología , Peso al Nacer , Índice de Masa Corporal , Glomerulonefritis/etnología , Nativos de Hawái y Otras Islas del Pacífico , Adolescente , Adulto , Australia/epidemiología , Femenino , Glomerulonefritis/etiología , Humanos , Incidencia , Enfermedades Renales/complicaciones , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Adulto Joven
8.
Pediatr Transplant ; 18(7): 689-97, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25039826

RESUMEN

Racial disparities in transplantation rates and outcomes have not been investigated in detail for NZ, a country with unique demographics. We studied a retrospective cohort of 215 patients <18 yr who started renal replacement therapy in NZ 1990-2012, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Primary outcomes were time to first kidney transplant, death-censored graft survival, and retransplantation after loss of primary graft. Europeans and Asians were most likely to receive a transplant (92% and 91% transplanted within five yr, respectively), and Pacific and Maori patients were less likely to receive a transplant than Europeans (51% and 46%, respectively), reflecting disparities in live donor transplantation. Pacific patients were more likely to have glomerulonephritis and FSGS. Pacific patients had five-yr death-censored graft survival of 31%, lower than Maori (61%) and Europeans (88%). No Pacific patients who lost their grafts were re-transplanted within 72 patient-years of follow-up, whereas 14% of Maori patients and 36% of European and Asian patients were retransplanted within five yr. Current programs to improve live and deceased donation within Maori and Pacific people and management of recurrent kidney disease are likely to reduce these disparities.


Asunto(s)
Etnicidad , Disparidades en Atención de Salud , Trasplante de Riñón/estadística & datos numéricos , Insuficiencia Renal/etnología , Insuficiencia Renal/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Glomerulonefritis/etnología , Glomerulonefritis/cirugía , Glomeruloesclerosis Focal y Segmentaria/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Nueva Zelanda , Grupos de Población , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Donantes de Tejidos , Resultado del Tratamiento
9.
Clin Nephrol ; 79(4): 285-91, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23320974

RESUMEN

Previous reports have suggested a poor renal prognosis in patients with HIV and HCV co-infection with a preponderance of immune complex mediated glomerular disease on biopsy. Although the benefits of HAART on HIVAN are known, its impact on co-infected patients is unclear. We describe the renal biopsy findings and renal outcome in 29 co-infected patients in the HAART era and compare them to findings in 14 historical controls reported from our institution in the pre-HAART era. Our present cohort was predominantly male and Black with the majority reporting a history of intravenous (i.v.) drug use. Renal biopsy findings included 16 patients with immune complex mediated glomerular disease and 14 patients with FSGS, of which only 3 had collapsing features and/or tubular microcysts typical of HIVAN. Five patients had other biopsy diagnoses not directly related to viral infection. Median renal survival in our cohort was 15.6 months - significantly better than the 1.7 months seen our pre-HAART cohort. The modern cohort's improved renal outcome occurred despite older patients, longer HIV infection and similar levels of renal insufficiency. Our data indicate a changing epidemiology and natural history of renal disease in the HAART era with less immune complex mediated glomerular disease and more non-collapsing FSGS of the usual type. The marked improvement is likely to be multifactorial, including use of antiretroviral and anti-HCV therapies, RAAS antagonists, earlier nephrology referral and generally improved medical care.


Asunto(s)
Nefropatía Asociada a SIDA/epidemiología , Coinfección , Glomerulonefritis/epidemiología , Infecciones por VIH/tratamiento farmacológico , Hepatitis C/epidemiología , Glomérulos Renales/patología , Nefropatía Asociada a SIDA/etnología , Nefropatía Asociada a SIDA/inmunología , Nefropatía Asociada a SIDA/mortalidad , Nefropatía Asociada a SIDA/patología , Adulto , Negro o Afroamericano , Complejo Antígeno-Anticuerpo/análisis , Terapia Antirretroviral Altamente Activa , Baltimore/epidemiología , Biopsia , Glomerulonefritis/etnología , Glomerulonefritis/inmunología , Glomerulonefritis/mortalidad , Glomerulonefritis/patología , Glomerulonefritis Membranoproliferativa/epidemiología , Glomerulonefritis Membranoproliferativa/patología , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Glomeruloesclerosis Focal y Segmentaria/patología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Hepatitis C/diagnóstico , Hepatitis C/etnología , Hepatitis C/mortalidad , Humanos , Estimación de Kaplan-Meier , Glomérulos Renales/inmunología , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Paris/epidemiología , Pronóstico , Estudios Retrospectivos , Abuso de Sustancias por Vía Intravenosa/etnología , Factores de Tiempo
10.
Clin Exp Nephrol ; 17(5): 646-649, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23239119

RESUMEN

Renal involvement with significant organ damage is common in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). As a result, it is independently referred to ANCA-associated renal vasculitis. Clinically, ANCA-associated renal vasculitis is characterized by rapidly progressive glomerulonephritis. Pathologically, it is defined by pauci-immune type necrotizing and crescentic glomerulonephritis. According to previous reports from all over the world, the etiology, prevalence, and prognosis of RPGN including ANCA-associated renal vasculitis varies among races and periods. To elucidate the clinical characteristics of Japanese RPGN patients, a registry derived from a questionnaire survey was established in 1999 and maintained until 2006. As a result, 1,772 cases were collected, analyzed, and reported previously. In this mini-review, we outline the characteristic clinical findings of Japanese patients (Asian) with ANCA-associated renal vasculitis, based on the registry data.


Asunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/etnología , Pueblo Asiatico , Glomerulonefritis/etnología , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/diagnóstico , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/inmunología , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Glomerulonefritis/diagnóstico , Glomerulonefritis/inmunología , Glomerulonefritis/terapia , Encuestas Epidemiológicas , Humanos , Japón/epidemiología , Pronóstico , Encuestas y Cuestionarios , Factores de Tiempo
11.
J Paediatr Child Health ; 49(10): 850-5, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23782011

RESUMEN

AIM: A nationwide 24-month study was conducted (2007-2009), via the New Zealand Paediatric Surveillance Unit to define epidemiology and clinical features of acute poststreptococcal glomerulonephritis (APSGN) in children hospitalised with the illness. METHODS: Paediatricians (n = 215) were requested to report new hospitalised cases fulfilling a case definition of definite (haematuria with low C3 and high streptococcal titres or biopsy proven APSGN) or probable (haematuria with low C3 or high streptococcal titres). RESULTS: A total of 176 cases were identified (definite: n = 138, probable: n = 38) with 63% residing in the Auckland metropolitan region. Sixty-seven percent were in the most deprived quintile. Annual incidence (0-14 years) was 9.7/100,000 (Pacific 45.5, Maori 15.7, European/other 2.6 and Asian 2.1/100,000). Annual incidence was highest in the South Auckland Metropolitan region (31/100,000), Central Auckland 14.9, West/North Auckland metropolitan region 5.9 and for the remainder of New Zealand 5.5/100,000. Age-specific incidence was highest in age 5-9 years (15.1/100,000). Reduced serum complement C3, gross haematuria, hypertension, impairment of renal function and heavy proteinuria were present in 93%, 87%, 72%, 67% and 44% of patients, respectively. Severe hypertension was closely associated with either symptoms of an acute encephalopathy or congestive heart failure. CONCLUSIONS: New Zealand children carry a significant disease burden of hospitalised APSGN with socio-economically deprived; Pacific and Maori children are being over-represented. Significant short-term complications were observed in hospitalised children with APSGN. Persistently very low rates in European/other suggest a preventable disease.


Asunto(s)
Costo de Enfermedad , Glomerulonefritis/epidemiología , Infecciones Estreptocócicas/complicaciones , Adolescente , Encefalopatías/etiología , Niño , Preescolar , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/etnología , Insuficiencia Cardíaca/etiología , Hospitalización , Humanos , Hipertensión/etiología , Incidencia , Lactante , Masculino , Nueva Zelanda/epidemiología , Estudios Prospectivos
12.
Kidney Int ; 82(12): 1321-31, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22932120

RESUMEN

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.


Asunto(s)
Enfermedades Renales/etnología , Riñón/patología , Nativos de Hawái y Otras Islas del Pacífico , Adulto , Australia/epidemiología , Biopsia , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Comorbilidad , Susceptibilidad a Enfermedades , Femenino , Glomerulonefritis/etnología , Glomerulonefritis/patología , Humanos , Incidencia , Enfermedades Renales/patología , Fallo Renal Crónico/etnología , Fallo Renal Crónico/patología , Glomérulos Renales/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Características de la Residencia , Factores de Riesgo , Terminología como Asunto , Factores de Tiempo
13.
Kidney Int ; 81(10): 1026-1032, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22297679

RESUMEN

Although unusual in western countries and in Australia in general, post-streptococcal glomerulonephritis (PSGN) is still common in Australian Aboriginal children living in remote communities. Here, we evaluated whether episodes of acute PSGN increased the risk for chronic kidney disease in later life in 1519 residents of a remote Aboriginal community (85% of those age eligible), with high rates of renal and cardiovascular disease, who participated in a health screen over a 3-year period. Of these, 200 had had at least one episode of PSGN, with 27 having had multiple episodes, usually in childhood. High levels of albuminuria (albumin/creatinine ratio) with increasing age were confirmed. All PSGN episodes were associated with group A streptococcal skin infections, often related to scabies. In both genders, aged 10-39 years at screening, about one in five had such a history. Among them, PSGN (5 years or more earlier) was significantly associated with higher levels of albuminuria than those without. In women, aged 30-39 years, a history of PSGN was associated with a significantly higher frequency of estimated glomerular filtration rates <60 ml/min. The adjusted odds ratios for an albumin/creatinine ratio over 34 g/mol (overt albuminuria) in males and females with a history of PSGN were 4.6 and 3.1, respectively, compared with those without a history. Thus, PSGN contributes to the very serious burden of chronic kidney disease in this community. Rigorous strategies to prevent scabies and Group A streptococcal infections will reduce this burden.


Asunto(s)
Glomerulonefritis/etnología , Enfermedades Renales/etnología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Escabiosis/etnología , Enfermedades Cutáneas Bacterianas/etnología , Infecciones Estreptocócicas/etnología , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Albuminuria/epidemiología , Australia , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Niño , Preescolar , Enfermedad Crónica , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Glomerulonefritis/diagnóstico , Humanos , Riñón/metabolismo , Riñón/fisiopatología , Enfermedades Renales/diagnóstico , Modelos Logísticos , Masculino , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Escabiosis/diagnóstico , Distribución por Sexo , Factores Sexuales , Enfermedades Cutáneas Bacterianas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Factores de Tiempo , Adulto Joven
14.
World J Surg ; 36(12): 2923-30, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22941236

RESUMEN

BACKGROUND: Successful renal transplantation has been performed in patients with end-stage renal disease and has been routine in patients with end-stage renal failure for more than two decades. Despite advances in the use of immunosuppressants, there has been only modest improvement in long-term allograft survival. Accumulating data have demonstrated that chronic rejection and recurrent glomerulonephritis are major causes of long-term allograft loss. However, data regarding the long-term impact of posttransplantation glomerulonephritis (PTGN) on ethnic Chinese populations are still unavailable. METHODS: From 1984 to 2010, a total of 268 patients who underwent renal allograft biopsies were reviewed retrospectively. Renal outcomes were compared by Kaplan-Meier analysis, and risk factors for renal survival and all-cause mortality were analyzed using the Cox proportional hazards model. RESULTS: In all, 85 patients (31.7%) had PTGN, and the mean time of disease onset was 5.32±5.18 years after transplantation. Among the 85 PTGN cases, 33 (39%) were immunoglobulin A (IgA) nephropathy, 24 (28%) were focal segmental glomerulosclerosis, and 8 (9.4%) were membranous GN. Significant risk was associated with posttransplant IgA GN in hepatitis B virus carriers (odds ratio 5.371, 95% confidence interval 1.68, 17.19; p=0.0064). A total of 45 PTGN patients had allograft loss, of whom 49% had IgA nephropathy. Patients with PTGN had inferior allograft survival rates compared to those with other pathologic findings (p<0.0003). CONCLUSIONS: Taken together, our results indicate that PTGN had a strong negative impact on long-term kidney graft survival. Posttransplant IgA nephropathy is a leading cause of allograft loss in Chinese kidney transplant patients with PTGN.


Asunto(s)
Glomerulonefritis/etiología , Supervivencia de Injerto , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Complicaciones Posoperatorias , Adulto , Pueblo Asiatico , China , Femenino , Estudios de Seguimiento , Glomerulonefritis/etnología , Humanos , Fallo Renal Crónico/etnología , Fallo Renal Crónico/mortalidad , Trasplante de Riñón/etnología , Trasplante de Riñón/inmunología , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etnología , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
15.
Nephrol Dial Transplant ; 25(12): 3962-9, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20525974

RESUMEN

BACKGROUND: Differences in epidemiology of kidney disease across the Middle East may arise from variations in indication for biopsy, environmental exposure and socio-economic status. The Lebanese population is composed of different ethnicities, with distinct ancestry and religion, enabling comparison of their effect on the prevalence of kidney disease within a confined geographic setting and uniform practices. Here we report 5 years' detailed epidemiology of renal diseases, based on histological diagnosis, in a sample from three large pathology centres in Lebanon. METHODS: Records of renal biopsies analysed at the American University of Beirut Medical Center, Hotel Dieu de France Hospital and the Institut National de Pathologie from January 2003 till December 2007 were retrospectively examined. We recorded the following data for each patient: age, gender, indication for renal biopsy and histopathological diagnosis. Religious affiliation and parents' consanguinity were recorded when feasible. RESULTS: The mean age at renal biopsy was 36.76 ± 20 years (range 1-84). The most common diagnosis was mesangioproliferative glomerulonephritis (GN; 20%), followed by focal segmental glomerulosclerosis (13.2%). While there were no differences in age, gender or indications for biopsy among different religious affiliations, mesangioproliferative GN was significantly more frequent among Muslims (P = 0.039) and offspring of consanguineous unions (P = 0.036). On the other hand, focal segmental glomerulosclerosis was most prevalent in Christians (P < 0.001). CONCLUSIONS: Variation in the distribution of diagnoses between Muslim and Christian groups likely reflects differences in population structure and ancestry. In particular, the increased prevalence of mesangioproliferative GN among offspring of consanguineous unions in Muslims suggests a recessive genetic component to this disease which may be identified via homozygosity mapping. These findings have important implications for formulating renal health policies and designing research studies in this population.


Asunto(s)
Cristianismo , Consanguinidad , Islamismo , Enfermedades Renales/etnología , Enfermedades Renales/epidemiología , Riñón/patología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biopsia , Niño , Preescolar , Femenino , Glomerulonefritis/epidemiología , Glomerulonefritis/etnología , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Glomeruloesclerosis Focal y Segmentaria/etnología , Encuestas Epidemiológicas , Humanos , Lactante , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto Joven
16.
Nephrology (Carlton) ; 15(6): 625-31, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20883283

RESUMEN

AIM: To investigate clinicopathological and prognostic differences between adults and children with acute post-streptococcal glomerulonephritis (APSGN). METHODS: A retrospective case series of 112 patients with APSGN was undertaken. Patients were divided into two groups according to age: adults aged more than 17 years and children aged less than 15 years. RESULTS: The incidence of APSGN, especially in adults, has decreased in the past three decades. Children have had a higher incidence of macroscopic haematuria than adults (58.3% vs 32.7%, P < 0.05). Laboratory test showed that red blood cell count of urine sediment in children was more significant. On light microscopy, adults had more global glomerulosclerosis, tubular basement membrane thickening, tubular atrophy and interstitial fibrosis, while children had more glomerular infiltrating neutrophils and monocytes and cellular casts. Immunofluorescence microscopy showed that classical staining was seen more in children. The short-term prognoses were good in both children and adults. But the recovery rate of proteinuria in children was faster than that in adults. CONCLUSION: Adults with APSGN had similar clinical features as children except that children had more significant haematuria. On pathology, adults had more outstanding chronic changes by light microscopy and more untypical staining by immunofluorescence.


Asunto(s)
Pueblo Asiatico , Glomerulonefritis/patología , Riñón/patología , Infecciones Estreptocócicas/patología , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Anciano , Biopsia , Distribución de Chi-Cuadrado , Niño , China , Proteínas del Sistema Complemento/inmunología , Recuento de Eritrocitos , Femenino , Glomerulonefritis/etnología , Glomerulonefritis/inmunología , Glomerulonefritis/microbiología , Hematuria/etnología , Hematuria/microbiología , Humanos , Incidencia , Estimación de Kaplan-Meier , Riñón/inmunología , Riñón/microbiología , Masculino , Microscopía Fluorescente , Persona de Mediana Edad , Pronóstico , Proteinuria/etnología , Proteinuria/microbiología , Infecciones Estreptocócicas/etnología , Infecciones Estreptocócicas/inmunología , Infecciones Estreptocócicas/microbiología , Factores de Tiempo , Urinálisis , Adulto Joven
19.
Nephrol Dial Transplant ; 23(11): 3571-7, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18577534

RESUMEN

BACKGROUND: Data from the United States and Canada suggest that survival rates of Caucasian dialysis patients are lower compared to those of black patients and patients from Asian regions. Information regarding the survival rate of immigrant dialysis patients in Europe is scarce. METHODS: We retrospectively analysed incident haemodialysis (HD) and peritoneal dialysis (PD) patients who entered an Amsterdam renal service between January 1996 and December 2005. To explore the origin of differences in survival between natives and immigrants, we ran a series of Cox models with adjustment for demographic, clinical and laboratory variables at baseline and initial adequacy variables. RESULTS: Of 303 incident dialysis patients, 58% were natives and 42% were immigrants. Fifty-nine percent of natives and 54% of immigrants had HD as initial treatment modality. At initiation of dialysis, native patients were older and had higher rates of vascular and coronary artery diseases and malignancies and a lower prevalence of hypertension. Glomerulonephritis was more common among immigrants as primary kidney disease. Mean haematocrit and calcium levels for natives were higher compared to immigrants. Cox proportional hazards analysis revealed an increased relative mortality risk (RR) of 2.7 [95% confidence interval (CI) 1.9-3.9] for natives compared to immigrants. Adjustment for age at the start of dialysis attenuated the RR to 1.9 (CI 1.3-2.7). Adjustment for the other variables did not materially influence this RR. CONCLUSIONS: We demonstrate increased survival for immigrant compared to native dialysis patients in an urban setting in the Netherlands. This survival advantage is only partly explained by younger age of immigrants at the start of dialysis compared to native patients.


Asunto(s)
Emigrantes e Inmigrantes , Glomerulonefritis/mortalidad , Glomerulonefritis/terapia , Diálisis Peritoneal , Diálisis Renal , Población Urbana , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Glomerulonefritis/etnología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos/epidemiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Tasa de Supervivencia
20.
Am J Trop Med Hyg ; 99(6): 1643-1648, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30398135

RESUMEN

Acute post-streptococcal glomerulonephritis (APSGN) is an inflammatory kidney disease following infection with nephritogenic strains of Group A Streptococcus. In 1991, APSGN became notifiable in the Northern Territory (NT) of Australia with cases recorded on the NT Notifiable Disease Database (NTNDS). The case definition of a confirmed case requires laboratory definitive evidence or laboratory suggestive evidence in conjunction with a clinically compatible illness. Probable cases require clinical evidence only. Acute post-streptococcal glomerulonephritis notifications from 2009 to 2016 were extracted from the NTNDS. Of the 322 cases, 261 were confirmed and 61 probable. The majority, 304 (94%), were Aboriginal and the median age was 8 years (range: 0-62 years). Incidence for confirmed cases was 13.8/100,000 person-years, with inclusion of probable cases increasing incidence to 17.0/100,000 person-years. Highest incidence of confirmed cases was in Aboriginal children less than 15 years of age at 124.0 cases/100,000 person-years. The rate ratio of confirmed cases in Aboriginal to non-Aboriginal Australians was 18.9 (95% confidence interval: 11.4-33.6). Recent trends show a consistently high number of notifications annually with less frequent outbreaks. The Aboriginal population of the NT continues to have high rates of APSGN with recent trends showing higher rates than previously reported. Sustained preventative efforts and continued surveillance strategies are needed.


Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades , Glomerulonefritis/epidemiología , Infecciones Estreptocócicas/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/etnología , Glomerulonefritis/microbiología , Humanos , Lactante , Recién Nacido , Riñón/microbiología , Riñón/patología , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico , Northern Territory/epidemiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/etnología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/patogenicidad , Población Blanca
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