Renal failure in Arnhem Land: missed opportunities for prevention and treatment

This is a brief clinical description of a group of people from an Arnhem Land community with a population of about 1500. The community has five people on full-time dialysis in Darwin, about 400 km away, and another four people who are being actively prepared for dialysis. Of these nine people, three come from within two generations of one clan: that is, from a group of about 40. This apparent family tendency is one of many factors producing kidney disease in Northern Territory Aboriginal people, who suffer extreme rates of end-stage renal failure (ESRF). Our understanding of these causes is quite embryonic. Despite several years of lobbying by Aboriginal health organisations the Northern Territory government has no coherent plans for ongoing prevention and management of kidney problems, and no services outside the main urban centres. The issues involved are discussed from the perspective of our bush clinic, kilometres away from renal biopsies and formal clinical research.