Once diabetes is established, the risk of DN may be increased by chronic or repeated infections. Australian researchers have documented a high prevalence of parasitic and bacterial infections among Aboriginals who later developed DN (56). The highest risk appears to result from repeated bacterial infections of the eyes, ears, nose, chest, skin, and gut. Although infections with streptococci are known to cause poststreptococcal glomerulonephritis (PSGN), a condition that is relatively common among Aboriginals (57), infections with other organisms may also contribute to progressive kidney disease in DN through immune activation and mesangial proliferation (58). Close living quarters and poor hygiene are largely responsible for the repeated bacterial and parasitic infections in the Aboriginal community.

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