‘18 per cent of all Indigenous Australian adults have chronic kidney disease—two times as likely as non-Indigenous Australians.’
This story is part of our 10 of the Best, 2016 edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects.
Team members: Associate Professor Gurmeet Singh and Professor Wendy Hoy
With nine per cent of Australian infants and 14 per cent of Indigenous Australians born prematurely, Professor Mary Jane Black and her team at the Biomedicine Discovery Institute at Monash University are examining the effect of preterm birth on the kidneys and what that means for long-term kidney health.
Normally the kidneys are formed prior to birth, with no new nephrons—functional units of the kidney—made after birth. However, in premature babies this formation continues to occur after birth, making the kidneys vulnerable to impaired development and injury and potential kidney disease in later life.
Professor Black decided to examine the causes, risk factors and the environment of premature babies to gain a better understanding of the processes of development after birth and how to mitigate any damage to the kidneys during this period.
‘In particular we looked at the effect of common causes of preterm birth—intrauterine growth restriction (IUGR) and infection of the amniotic sac—and how they affect the development of the kidneys in the first month of life,’ Professor Black said.
‘Our studies have shown that both IUGR and amniotic sac infection can adversely impact nephron development—leading to a significant reduction in the number of glomeruli (filtering components of the nephron), affecting kidney function.’
The outcomes of this research will lead to a better understanding by clinicians of the adverse effects of preterm birth and its causes on renal structure and function.
‘It is envisaged this will lead to both IUGR and premature birth being considered as risk factors for long-term kidney disease, and will facilitate more rigorous assessment of kidney function in premature babies,’ she said.
The very high incidence of kidney disease in adult Indigenous Australians may be a legacy of the improved survival of these infants over recent decades.
‘Our findings indicate that many Indigenous infants will be discharged from hospital whilst still suffering kidney impairment,’ she explained.
‘It is envisaged that when clinicians are alerted to our findings that these infants will be more closely monitored following discharge to help prevent further kidney impairment and also help to improve overall the health in Indigenous children who were born preterm.’
'Overall it will lead to better follow-up of kidney function by paediatricians in infants born prematurely, which will help to prevent the progression to chronic kidney disease.'
Next steps
Professor Black and her team are now preparing to conduct new research in this study, with the specific aim of determining the underlying causes of kidney vulnerability in Indigenous premature infants. They consider that the early life injury to the kidneys of Indigenous infants following premature birth is a major contributor to their exceptionally high incidence of chronic kidney disease in adulthood.
1 Australian Institute of Health and Welfare (AIHW), 2016, cardiovascular disease, diabetes and chronic kidney disease - Australian facts: Aboriginal and Torres Strait Islander people, in Cardiovascular, diabetes and chronic kidney disease series.
