Acute post-strep­to­coc­cal glomeru­lonephri­tis – oth­er­wise known as APS­GN – is an inflam­ma­to­ry dis­ease of the kid­neys fol­low­ing a skin or throat infec­tion with Strep­to­coc­cus pyo­genes, known as group A strep­to­coc­cus (GAS), or occa­sion­al­ly groups C or G streptococcus.

In Aus­tralia, reports sug­gest Abo­rig­i­nal and/​or Tor­res Strait Islander chil­dren have amongst the high­est rates of APS­GN report­ed world­wide, and the rate of new cas­es has increased over the last 25 years. Despite this, still so much is unknown about APS­GNs preva­lence in Aus­tralia and a lot of more can be done in the pre­ven­tion of the disease.

What is APS­GN and how is it caused?
APS­GN stands for acute post-strep­to­coc­cal glomeru­lonephri­tis. It’s an autoim­mune response after expo­sure to a Strep A infec­tion (e.g. ton­sil­li­tis, impeti­go). Autoan­ti­bod­ies that are sup­posed to tar­get the Strep A infec­tion instead tar­get the kidneys.

What is your cur­rent expo­sure to APS­GN?
We see quite a bit of APS­GN in Far North Queens­land and there is emerg­ing evi­dence that an episode of APS­GN increas­es a patient’s risk of chron­ic kid­ney dis­ease lat­er in life. Par­tic­u­lar vir­u­lent strains of Strep A can spread quick­ly through a com­mu­ni­ty and cause an APS­GN out­break. All these things are impor­tant to under­stand bet­ter in order to try and reduce and ulti­mate­ly pre­vent cases.

What are the com­mon symp­toms and com­pli­ca­tions asso­ci­at­ed with APS­GN?
The symp­toms include: oede­ma (facial or periph­er­al), hyper­ten­sion and haema­turia. Com­pli­ca­tions range from hyper­ten­sive cri­sis
(acute) through to chron­ic kid­ney dis­ease (chron­ic).

What trends have you observed in the inci­dence of APS­GN in Aus­tralia over recent years?
We know that there are high­er rates of APS­GN in First Nations com­mu­ni­ties, espe­cial­ly those who are socio-eco­nom­i­cal­ly dis­ad­van­taged, as this essen­tial­ly is a dis­ease of socio-eco­nom­ic dis­ad­van­tage. But over­all, I don’t think we real­ly have a good grasp on the true inci­dence of APS­GN in Aus­tralia. I would hope that as socio-eco­nom­ic dis­ad­van­tage improves over time, APS­GN cas­es will decline.

How does the preva­lence of APS­GN in First Nations com­mu­ni­ties com­pare to oth­er pop­u­la­tions in Aus­tralia?
Although the evi­dence is lim­it­ed, some stud­ies have report­ed that the preva­lence of APS­GN in First Nations com­mu­ni­ties is high­er than non-First Nations com­mu­ni­ties.

What are the major chal­lenges in address­ing APS­GN out­breaks in remote com­mu­ni­ties?
There are many chal­lenges includ­ing access to remote loca­tions (espe­cial­ly in the wet sea­son when trans­port may be lim­it­ed) and human resources (out­break respons­es are resource inten­sive and often require a team to fly into a com­mu­ni­ty and work in part­ner­ship with the local staff).

What pre­ven­ta­tive mea­sures can com­mu­ni­ties take to reduce the inci­dence of APS­GN?
Have you heard of the nine healthy liv­ing prac­tices? These are: wash­ing peo­ple, wash­ing clothes and bed­ding, remov­ing waste­water, improv­ing nutri­tion, reduc­ing over­crowd­ing, reduc­ing insect bites, reduc­ing impacts of dust, con­trol­ling the tem­per­a­ture of the liv­ing envi­ron­ment, reduc­ing haz­ards that cause trauma.

How effec­tive are cur­rent treat­ment options for APS­GN, and what is the prog­no­sis for affect­ed indi­vid­u­als?
Cur­rent treat­ments for APS­GN include stop­ping the Strep A with a long act­ing peni­cillin antibi­ot­ic; man­ag­ing high blood pres­sure with anti­hy­per­ten­sives; and man­ag­ing oedema.

What pol­i­cy changes would you advo­cate for to improve the man­age­ment and pre­ven­tion of APS­GN in Aus­tralia?
Healthy hous­ing is a human right. Yet in Aus­tralia – many peo­ple of all eth­nic­i­ties do not live in safe and healthy hous­ing. This is everybody’s issue that we must address at a local, state and nation­al level. 

How can health­care sys­tems bet­ter engage with First Nations com­mu­ni­ties to address health dis­par­i­ties relat­ed to APS­GN?
Ensur­ing any local pub­lic health respons­es are First Nations-led and in close part­ner­ship with local First Nations com­mu­ni­ties (for exam­ple the local coun­cil and local health­care centre).

What do you see as the future direc­tions for research and pub­lic health pol­i­cy regard­ing APS­GN?
We need to bet­ter under­stand APS­GN across all of Aus­tralia. There has been fan­tas­tic epi­demi­o­log­i­cal research from the North­ern Ter­ri­to­ry, how­ev­er we need to under­stand the dis­ease in oth­er areas such as Queensland.

Are there any promis­ing devel­op-ments, such as poten­tial vac­cines or inno­v­a­tive treat­ment strate­gies, on the hori­zon for APS­GN?
The Aus­tralian Strep A Vac­cine Ini­tia­tive (ASAVI) is an Aus­tralian-led glob­al ini­tia­tive with the goal of reduc­ing the dis­ease bur­den caused by Group A Strep­to­coc­cus (Strep A) infec­tion through effec­tive vaccination.

Ref­er­ences

https://​www​.health​.qld​.gov​.au/​cdcg/ index/a­cute-post-strep­to­coc­cal-glomeru­lonephri­tis-aps­gn