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Indigenous CKD Pathology — RACP Adult Medicine MCQ

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HardNephrologyIndigenous CKD PathologyRACP Adult Medicine

A 42-year-old Aboriginal man from Central Australia presents with chronic kidney disease (eGFR 35 mL/min/1.73 m²) and heavy proteinuria (urine ACR 250 mg/mmol). He has type 2 diabetes and hypertension. Renal biopsy shows features consistent with both diabetic nephropathy and focal segmental glomerulosclerosis. What is the unique renal histological pattern sometimes seen in Aboriginal Australians with CKD?

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Correct answer: E — Thin basement membrane disease

Aboriginal and Torres Strait Islander Australians have a 3–5× higher rate of CKD and ESKD compared to non-Indigenous Australians. A unique histological pattern termed 'non-diabetic renal disease' (sometimes called oligomeganephronia or reduced nephron number pathology) features enlarged glomeruli with secondary FSGS, reflecting congenital nephron deficit. Low birth weight (common in Indigenous communities due to intrauterine malnutrition) leads to reduced nephron endowment, with subsequent hyperfiltration and glomerular hypertrophy predisposing to early CKD when additional insults (diabetes, hypertension, infections) occur. This underscores the importance of addressing social determinants of health.

Reference: KHA-CARI – 2024 – Indigenous Kidney Health; ANZSN – 2024