Sick kidneys—an insight into post streptococcal glomerulonephritis in Central Australia
Sick kidneys—an insight into post streptococcal glomerulonephritis in Central Australia Conference Paper
15th National Rural Health Conference: Better together!
- Author(s): Dowler, James, Wilson, Angela
- Secondary Author(s): Coleman, Leanne
- Published: 2019
Abstract: Acute post infectious glomerulonephritis (APIGN) is predominantly a disease of poverty and disadvantage, complicating prior infection with Group A streptococcus. The highest documented global rate of this disease is seen in Indigenous Central Australians (98 cases per 100,000 people). Alice Springs Hospital services an area of Central Australia covering 900,000 km2 and a population of 48,000 people, of whom 44% identify as Aboriginal or Torres Strait Islander. As the referral centre for Central Australia, Alice Springs Hospital sees a large number of children presenting with symptomatic Acute Post infectious Glomerulonephritis (APIGN). This study presents 5 years of admissions data to better understand the clinical course and burden of paediatric APIGN in Central Australia. Methods: This retrospective observational descriptive study presents all cases of APIGN diagnosed in children under 14 between 2010 until 2015. Cases of APIGN were confirmed using the Northern Territory Centre of Disease Control case definition guidelines. Case notes and electronic medical data were reviewed and data relating to clinical presentation, management and outcomes were collected. Results: 69 cases APIGN were diagnosed over the study period. All cases were in Indigenous children aged 1 to 12years. Preceding skin infection was identified in 65.2% of cases. Common complications included moderate hyperkalaemia (K³6) (15.9%), renal impairment (81.2%), oedema (60.9%) and hypertension (72.5%). Diuretic and antihypertensive therapy were used in 75.4% and 53.6% of patients respectively. Fluid restriction occurred in 65.2% of patients for a mean of 8.9 days. Long acting benzathine penicillin was given in only 34.8% of cases. Co-occurring infections were common, including scabies/headlice (47.8%), urinary tract infection (18.8%) and pneumonia (18.8%). Mean hospital stay was 10.46 days (2-37), 2 cases required transfer to a tertiary centre. Repeat complement levels were performed in 42 cases (60.9%) at a mean of 297days. There was no evidence of ongoing renal impairment in cases (mean follow up 1621 days following diagnosis). Conclusion: APIGN is a common presentation in Aboriginal children in Central Australia, and often requires prolonged hospital admission. Children admitted to hospital require close monitoring due to the frequency of renal impairment and associated complications. Skin infection is the major exposure to Group A streptococcus and community and public health measures to limit Group A streptococcal exposure continues to be a priority in Aboriginal Health. These data have been used to develop guidelines to assist with the management and follow up of paediatric patients in Central Australian with APIGN.
- Urls: http://www.ruralhealth.org.au/15nrhc/sites/default/files/A2-4_Dowler.pdf Available from, www.ruralhealth.org.au/15nrhc/program/concurrent-speakers/ Download site
- Publisher Location: Hobart