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Preventive treatment of the population in order to stop the development of CKD

In order to get the clearest idea of CKD nosologic composition, it is necessary to establish the system of early detection and registration of patients (CKD screening and register) and provide widespread availability of renal biopsy at early stages of proteinuric nephropathies.

Currently available data testify to the prevalence of secondary nephropathies among the population. In different countries, the first place is shared by diabetic and cardiovascular renal injuries (diabetic and hypertensive nephropathies, ischemic kidney disease). Taking into account the steady growth of the number of diabetes mellitus patients among the population, it is possible to expect that the share of secondary nephropathies will be even higher in the CKD structure. A significant part of CKD patients are people with chronic glomerulonephritis, chronic interstitial nephritis (analgesic nephropathy occupies a special position), chronic pyelonephritis and polycystic kidney disease. Other nosologies take place significantly less frequently.

Chronic kidney disease (CKD) diagnostics system

 

As it was mentioned before, screening (within the framework of global periodic health examinations) and preventive measures among the entire population appear to be the most reliable methods of struggling against CKD. Any person who looks after their health (especially, at the age of 50+ y.o.) is recommended to undergo a minimal set of examinations to detect CKD every year. A target work with people from the CKD risk group is a less expensive method.

Patients with firstly diagnosed chronic kidney disease should undergo a nephrologist’s consultation and extended nephrological examination in order to make a nosologic diagnosis and select etiotropic and pathogenetic treatment.

Indications to Outpatient Nephrological Consultation:

Firstly diagnosed and confirmed by subsequent examinations: 

  • Proteinuria
  • Microalbuminuria
  • Hematuria
  • Decrease in GFR to less than 60 ml/min/1.73 m2
  • Increased creatitine or blood urea level
  • Arterial hypertension firstly detected at the age under 40 or over 60 y.o. Treatment-resistant arterial hypertension
  • Impaired concentration function of the kidneys, tubular disorders (nycturia, polyuria, stable decrease in urine specific gravity, glycosuria with normal blood sugar level)

 
Indications to Hospitalization to Inpatient Nephrology Department: 

  • Oliguria (diuresis under 500 ml/day), anuria
  • Rapidly progressing loss of kidney function (double increase in the blood creatitine level in less than 2 months)
  • Firstly diagnosed decrease in GFR to less than 30 ml/min or blood creatitine level equal or over 250 mcM/l for males and equal or over 200 mcM/l for females
  • Nephrotic syndrome (proteinuria over 3 g/d, hypoalbuminemia)
  • Firstly diagnosed pronounced urine syndrome (proteinuria over 1 g/d)


Main Tasks of Nephrological Examination
 

  • To specify a nosologic diagnosis
  • To specify a stage of CKD
  • To detect CKD complications
  • To detect comorbidities
  • To examine possible CKD progression risk factors
  • To assess overall and renal prognosis, CKD progression rate
  • To detect patients with the nearest ESRD threat and register them in a dialysis center
  • To develop tactics of etiotropic, pathogenetic and nephroprotective therapy
  • To provide patients with recommendations on the dieting and lifestyle in order to reduce CKD progression and cardiovascular risks
  • To define the frequency of further examinations by therapists and nephrologists