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Keywords:

  • Aboriginal Australians;
  • renal failure;
  • renal ultrasound;
  • structural abnormalities;
  • urinary abnormalities

SUMMARY:

Background:  Rates of albuminuria and haematuria are extremely high with haematuria prevalence as high as 30–50% in adults of some Aboriginal groups. Dipstick testing of urine is routinely carried out in Aboriginal communities and as part of school screening programmes. Evaluation of the many affected individuals has traditionally included renal ultrasound examination, which involves considerable expense and logistic problems in remote communities. The present study was conducted to evaluate the usefulness of ultrasound in this setting.

Methods:  A population survey was conducted in a remote community. Urine dipstick analysis and the albumin : creatinine ratio (ACR; g/mol) were measured in 1440 people over 5 years of age (89% of the eligible population), and a detailed renal ultrasound examination was performed in a random subset of 647 people (41.1% of the whole group), 276 aged 5–19 years and 371 over 20 years of age.

Results:  Urine dipstick proteinuria (>1+) was present in 8.5% (23/271) of those aged 5–19 years and 37.9% (132/348) in those aged over 20 years; pathological albuminuria (ACR > 3.4) was present in 7.6% (21/276) and 54.7% (203/371), respectively, and isolated haematuria was present in 7.7% (21/273) and 11.5% (40/347), respectively. Eight ultrasound abnormalities were found. Ultrasound findings did not change the management of any individual.

Conclusion:  Renal ultrasound added little to the evaluation of people with asymptomatic proteinuria or haematuria in this setting. In this scenario, ultrasound examination could be reserved for the cases with an unusual presentation where findings are likely to influence the prognosis or treatment, or in preparation for a renal biopsy.