T PHAM1, M ALJISHI1, J CHAN1, T HAN1,3, M MCGRAIL3, J BORG1, J MOORE1, D RANGANATHAN2,4, Z THET1,3,4
1Department of Nephrology, Central Queensland Hospital & Health Service, Rockhampton , Australia, 2Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 3The University of Queensland, Rural Clinical School, Rockhampton, Australia, 4The Griffith University, Brisbane/Gold Coast, Australia
Aim: To determine the effect of a severe cyclone on incidence of glomerular disease (GD) in Central Queensland, Australia.
Background: There is a growing body of evidence that incidence of GD is increased by environmental pollution. To date, no studies have investigated any correlation between severe cyclone and the incidence of GD.
Methods: This was a retrospective observational single region study of all GD 3 years pre- and post-cyclone Marcia which occurred on 20th February 2015. Exclusion criteria were GD due to hepatitis B or C virus, HIV-associated nephropathy, plasma cell dyscrasias, and paraneoplastic glomerulopathy.
Results: There was an increased rate of anti-neutrophil cytoplasmic antibodies (ANCA) associated renal vasculitis (AAV) following Cyclone Marcia (pre-cyclone: 1 case, 1.5 cases per million person years (95% confidence interval (CI): 1.5 to 4.5)) to post-cyclone: 10 cases, 15.1 cases per million person years (95% CI: 5.5 to 24.6) with incidence rate ratio (IRR): 10.0 (95% CI: 1.4 to 444.0), p=0.006). There was no change in incidence rate of other GD diseases such as IgA nephropathy (3 cases vs. 8 cases, IRR: 2.7 (95% CI: 0.6 to 15.6), p=0.15), lupus nephritis (1 case vs. 4 cases, IRR: 4.0 (95% CI: 0.4 to 197.0), p=0.22), membranoproliferative glomerular nephritis (0 cases vs. 2 cases), membranous nephropathy (3 cases vs. 7 cases, IRR: 2.3 (95% CI: 0.5 to 14.0), p=0.23) and minimal change disease (2 cases vs. 3 cases, IRR: 1.5 (95% CI: -3.7 to 21.9, p=0.69).
Conclusions: This study suggested an association between a category V cyclone and increased incidence in AAV. This association was not observed in IgA nephropathy, lupus nephritis, membranoproliferative glomerular nephritis, membranous nephropathy and minimal change disease.
Tony Pham MD is an intern at Rockhampton Base Hospital. He has a keen interest in nephrology and research overall, publishing 7 articles in his short academic career. He is currently studying an MPH has an extensive research background, working previously as a research assistant in forensic medicine.