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Kidney disease in Aboriginal Australians perpetuates poverty

The recent death of the lead singer of Yothu Yindi, is a high-profile example of an event all too common in Aboriginal Australia. Older Aboriginal Australians (40 to 60 years old) are more than 15 times…

Older Aboriginal Australians are more than 15 times more likely to die of kidney disease than non-Aboriginal Australians. Helen Taylor

The recent death of the lead singer of Yothu Yindi, is a high-profile example of an event all too common in Aboriginal Australia.

Older Aboriginal Australians (40 to 60 years old) are more than 15 times more likely to die of kidney disease than non-Aboriginal Australians. This is an age that’s normally the prime life. But not only is it a tragedy for the individuals involved but has a much wider effect on the community.

Elders in all communities are a repository of knowledge and of accumulated wealth. Early death of key older family members deprives younger community members of the benefit of accrued knowledge of culture and both financial and social support.

The structure of the broader Australian population is like a pillar with similar numbers of people in all age groups. This means that a young non-Aboriginal child will often receive support and guidance from two mature adults with back up from four, still-living grandparents.

The population structure in Aboriginal Australia is quite different and is more like a triangle, with many more children than adults and even fewer living grandparents. This means that an Aboriginal child receives support and guidance from far fewer adults.

This pyramid like structure is generated partly by early death of Aboriginal adults from heart disease, diabetes and kidney disease.

Not a great start

Heart disease, diabetes and kidney disease are non-communicable diseases that are strongly influenced by the environment. Increasing evidence suggests that all three begin as the baby is developing in the uterus. This concept is known as fetal programming or the developmental origins of adult health.

Let us explain by using kidney disease as an example to illustrate the concept. Skin sores can become infected with the bacteria known as streptococcus, this type of infection can lead to kidney damage known as glomerulonephritis. This can happen in childhood, and, if it happens to a girl, her kidneys may already be damaged by the time she becomes pregnant.

The insidious cycle of kidney disease in the Aboriginal population. Jonathan Paul

Studies in pregnant sheep have demonstrated that if the mother’s kidney function is damaged, then the kidneys of the developing fetus also become damaged. This allows kidney damage to be passed across generations.

Studies by others suggest that this is happening to many Aboriginal mothers and their babies. Aboriginal mothers often have evidence of kidney disease already present during pregnancy and Aboriginal babies are frequently born with a much smaller number of nephrons (the functional units of the kidney). Typically around 400,000 while non-Aboriginal babies have over one million.

This reduction in nephron numbers is linked to impaired growth within the uterus of many Aboriginal babies who are born too small (known as growth restriction), twice as often as non-Aboriginal babies.

A better way forward

If we are to close the gap in Aboriginal life expectancy and well-being, we need to focus on the beginning of life inside the uterus. We need to ensure high quality care and support for Aboriginal mothers and their babies.

We need to develop ways of identifying babies at risk of kidney disease early to prevent deterioration of kidney function that could be transmitted across generations into the future.

Progress is being made. In Tamworth, a research team from the University of Newcastle’s department of rural health is recruiting young Aboriginal mums and their children and seeking to identify markers of kidney impairment in urine samples.

In Townsville, a neonatologist is using retinal photographs of newborn babies’ eyes to identify those at risk of kidney disease (the blood vessels at the back of the eye reflect the way the blood vessels in the kidney are also developing).

If we can reduce the burden of kidney disease, we can improve not only the health of Aboriginal Australians but also their cultural and material wealth by allowing more older Aboriginal people to transmit their knowledge and resources to the next generation. Intervening early in life to optimise health is a much more effective strategy than trying to correct accumulated damage in later life.

Acknowledgement: Della Yarnold also contributed to this article.

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13 Comments sorted by

  1. Stephen Ralph

    carer

    What puzzles me is that for decades many millions of dollars have been directed towards Aboriginal communities, but still issues such as this and others continue to be a scourge of the communities.

    Money seems to be wasted ..........the issues of health and education seemingly addressed in ad hoc ways that solve very little.

    What are the problems that stop the money being better spent, and allowing aborigines the opportunity to get what the rest of Australians take for granted?

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    1. Greg North

      Retired Engineer

      In reply to Stephen Ralph

      You are seeing in this report Stephen, an example of research that is being directed at making improvements and aside from research itself costing money, it obviously also takes much time.

      There has I suspect at times been thoughts that kidney and liver damage has been brought about more from consumption habits and the findings of genetic transmission is a step forward.

      I'd expect that resolving it throughout indigenous communities is going to take generations for not only will it mean wide spread regular testings, there'll also be the need for education on taking better care re skin breaks etc. so as to restrict non genetic development.

      In addition to money which is often in short supply because of over spending and all governments having other priorities, there is also the people requirement, the people to work on such projects, many being required continuously just for monitoring and indigenous communities are located in some remote places.

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    2. David Thompson

      Marketing Research

      In reply to Stephen Ralph

      Many "millions"? Hardly. Try BILLIONS. And good luck taking that money away from the patrons in the Aboriginal Industry, whose empires depend on ongoing tawdriness and dissolution among their clients in remote hell-holes. While Aborigines continue to have so much welfare thrown at them to stay in these hell-holes, it will remain criminally disingenuous to talk about "closing the gap". Any gap.

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    3. David Thompson

      Marketing Research

      In reply to Greg North

      Alternatively, they could move.

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    4. John Crest

      logged in via email @live.com.au

      In reply to Stephen Ralph

      You've hit the nail on the head. This seems to be a problem money can't fix.

      So, what IS the problem?

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  2. Greg North

    Retired Engineer

    " This allows kidney damage to be passed across generations. "

    The findings of this study are a great step forward and I imagine the next steps are to look at what ways there are if any to prevent that genetic passing as well as arresting the development in new born.

    " Aboriginal mothers often have evidence of kidney disease already present during pregnancy and Aboriginal babies are frequently born with a much smaller number of nephrons (the functional units of the kidney). Typically around…

    Read more
    1. Stephen Ralph

      carer

      In reply to Greg North

      Thanks Greg...

      There is a Minister and presumably a bevy of bureaucrats who oversee Aboriginal affairs - this must mean a considerable budget for the area. Are there too many snouts in the trough?

      There are also the numerous Aboriginal bodies who may or may not be adding to the problem - a case of of not using their allocated funds wisely. Personally I don't think money is the issue.

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  3. Tom Hennessy

    Retired

    "Mechanisms of development and progression of cyanotic nephropathy"
    "Hyperviscosity by polycythemia may be responsible for the development
    of CN"

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  4. Paul Prociv

    ex medical academic; botanical engineer

    While chronic renal disease is a major problem among indigenous people, especially those in remote communities, this should not be viewed in isolation as a specific medical challenge, for it reflects a much more fundamental and general health situation, which no amount of thoughtless, kneejerk funding (apparently the only approach most politicians know) will solve. Of course, childhood infections, including those of the skin and upper respiratory tract, feed into kidney damage, but so do diabetes…

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  5. Isabelle Ellis

    Professor of Rural and Regional Nursing at University of Tasmania

    Hi Roger, Kirsty and Della,
    thanks for your interesting article.
    Good to see that researchers are looking at novel ways of identifying renal health of newborns to try and avert the terrible scourge of kidney disease.
    The really alarming statistic is the magnitude of the problem of renal disease. I would have liked you to identify the cost of providing renal dialysis care for people diagnosed with end stage renal failure and the shocking gap in the staging of renal disease for people living in remote Australia. The more remote you are the less likely you are to have your renal disease treated early resulting in a guarantee of a worse outcome. Fixing this problem takes improving access to specialist renal care for those who need it most. Unfortunately renal physicians and endocrinologists are an endangered species in the bush.

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  6. Kate Newton

    logged in via email @ymail.com

    As a non-medico I had never heard of this bacterial origin and in utero transmission of kidney disease before. When I would read in the media that indigenous people were dying early of kidney disease I tried to understand what was happening as a layperson. The answer I usually seemed to come up with was late onset diabetes.

    So is this article reporting a new finding? It seems pretty revolutionary to me.

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  7. Roger Smith

    Director of The Mothers and Babies Research Centre at the Hunter Medicial Research Institute at University of Newcastle

    Thank you for all your comments.
    We wanted to highlight three major points-
    1) That kidney disease in very common in the Aboriginal community
    2) That the disease often starts in utero
    3) That when adults die in the prime of their lives it truncates their capacity to pass on material wealth and cultural knowledge to their children and grand children and this processes perpetuates poverty.
    We agree that kidney disease is not the only problem, diabetes and heart disease are important and also likely begin inside the uterus. We also agree that the solutions are complex but a key factor is providing a good education to Aboriginal women who then become mothers. There is a strong association between the level of education of the mother and the health of the child throughout life. Promoting the status of women is a key intervention in all under-privileged groups.

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  8. Michelle Moseley

    logged in via Facebook

    "Intervening early in life to optimise health is a much more effective strategy than trying to correct accumulated damage in later life."
    I have nursed in remote communities and have to agree that as difficult and frustrating as it can often seem, educating children consistently from the youngest age possible is a large part of the solution.

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