ARDAC (Antecedents of Renal Disease in Aboriginal Children) Follow-up Study

世界各地的土著居民比非土著居民有更高的肾衰竭率。澳大利亚土著居民的肾衰竭率是世界上最高的，尤其是那些生活在偏远地区的人。造成这种情况的原因很复杂，其中包括众所周知的环境风险因素，这些因素导致土著人民患上许多疾病——社会经济劣势、较高的感染率、吸烟、酗酒和营养不良。还有一些更具体的肾脏疾病的生物学风险因素，如低出生体重婴儿、肾脏体积缩小、女性、肾脏疾病家族史、遗传影响、营养过剩和营养不足以及高血压。这些风险中有许多可能在儿童时期发生，导致隐性肾损害，在成年后，当糖尿病和其他影响发生作用时，可能变成慢性肾损害。为了在成人混杂因素使情况复杂化之前阐明早期影响对土著居民肾脏疾病的风险程度，计划对表面健康的土著儿童进行肾脏疾病早期症状的独特研究。这些学生来自新南威尔士州的不同地区，并且有一个非土著比较组。第一个主要目标已经完成：确定：与非原住民儿童相比，原住民儿童的血液和尿液中蛋白质的比率，以及高血压。这些是肾脏疾病的早期标记或前兆；2. 如果这些前因在城市、沿海、农村和偏远地区以及社会经济地区有所不同；3. 前事与其他风险因素（如年龄、性别、出生体重和生长）之间的关联；次要目标正在进行中：确定：1；通过对这些儿童进行4年的随访了解这些肾脏疾病前兆的自然病史；2. 哪些风险因素更可能发生在有持续前因的儿童身上-即儿童更有可能发展成严重的肾脏疾病。

Indigenous people world-wide have higher rates of kidney failure than non-Indigenous people. Aboriginal Australians have the highest rates of kidney failure in the world, especially in those living in remote areas. The reasons for this are complex, and include well-known environmental risk factors that contribute to many diseases in Aboriginal people - socio-economic disadvantage, higher rates of infection, smoking, alcohol abuse and poor nutrition. There are also biological risk factors more specific to kidney disease such as low birth weight babies, reduced kidney volume, female sex, family history of kidney disease, genetic influences, over and under-nutrition and high blood pressure. Many of these risks may take effect in childhood, resulting in silent kidney damage that may become chronic in adulthood when diabetes and other influences take effect. In order to clarify the degree of risk early influences have on Aboriginal kidney disease before adult confounders complicate the picture, a unique study of early signs of kidney disease in outwardly healthy Aboriginal children was planned. These school children come from different locations across NSW, and have a non-Aboriginal comparator group. The first primary aims are complete: To determine: 1. Rates of blood and protein in the urine, and high blood pressure in Aboriginal as compared to non-Aboriginal children. These are the early markers, or antecedents of kidney disease; 2. If these antecedents differ over urban, coastal, rural and remote regions, and socio-economic areas; 3. Any association between antecedents and other risk factors such as age, gender, birth weight and growth; Secondary aims are currently underway: To determine: 1. The natural history of these antecedents of kidney disease by following these children for a further 4 years; 2. Which risk factors are more likely in children with persisting antecedents -ie the children more likely to develop serious kidney disease.