The burden of infection contributes to chronic renal disease (RD) in Aboriginal communities

Aboriginal people in remote areas are experiencing an epidemic of RD and cardiovascular disease (CVD). They also have high rates of infections, related to poor living conditions. We have described a multideterminant model of RD in this setting, including Syndrome X features, low birth weight, heavy drinking and current skin infections. We now describe associations with inflammation and infection. Studies were performed in two remote NT communities (C1 & C2) 900 km apart; 90% of adults in C1 and 60% in C2 participated. Urine albumin/creatinine ratio (ACR) was the RD marker. Various markers of infection/ inflammation and a variety of CVD risk markers were assayed, and in C2, carotid intima-media thickness (CIMT), an indicator of CVD. RD was pervasive, with rates of microalbuminuria (ACR 3.4–33 g/mol) and overt albuminuria (ACR 34+) of 28% and 21% in C1, and of 29% and 13% in C2. ACRs were inversely correlated with calculated GFR. ACR was significantly correlated with CVD risk markers. In C1, ACR was associated with H. pylori antibody (300 +), with the combination of C.pneumoniae and H. pylori antibodies, and with scabies and a history of poststreptococcal glomerulonephritis (PSGN). In C2, CRP concentrations were high (median 7 mg/L), and correlated with ACR; ACR also correlated with fibrinogen and IgG levels, with high titre CMV antibody, and with CIMT. CIMT, in turn, was correlated with several infectious and inflammatory markers. Infections and inflammation are associated with RD in this setting. Specific nephropathies aside (e.g. PSGN), this might reflect a general vasculopathic effect of the burden of infection, and another link between CVD and RD, through shared risk factors