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Early detection and treatment of the patients with the early stage of CKD in order to cease the disease development

Renal injury markers are any changes that are detected in the course of a clinical-laboratory examination and connected with pathological processes in the renal tissue (table 1).

Table 1. Main renal injury markers making it possible to suspect CKD

Marker

Comments

Albuminuria/ proteinuria

Persistent increase in the excretion of albumin with urine; more than 10 mg/d (10 mg of albumin/g of creatitine) – see the recommendation

Persistent changes in the urine sediment

Erythrocyturia (hematuria), cylindruria, leukocyturia (pyuria),

Renal changes detected by imaging techniques

Abnormal development of the kidneys, cysts, hydronephrosis, changes in the kidney dimensions, etc.

Changes in the blood and urine composition

Changes in the serum and urine concentration of electrolytes, ABB disorders, etc., including changes typical of tubular dysfunction syndrome (Fanconi syndrome, renal tubular acidosis, Bartter syndrome, Gitelman syndrome, nephrogenic diabetes insipidus, etc.)

Persistent reduction of the glomerular filtration rate to less than 60 ml/min/ 1.73 sq. m

In the absence of other renal injury markets (see the recommendation)

Pathomorphological renal tissue changes detected by means of intravital nephrobiopsy

Should be taken into account; changes clearly testifying to chronization of the process (sclerotic changes in the kidneys, changes in the membranes, etc.)


CKD is an over-nosologic notion; at the same time, it is not a formal umbrella term for chronic renal injuries of different nature.

The reasons for singling out this notion are based on the unity of the main pathogenetic progression mechanisms of the pathological process in the kidneys, similarity of many risk factors for disease development and progression in case of renal injuries of different etiology and primary and secondary prevention measures arising from it.

The diagnosis of CKD should be made on the basis of the following criteria: 

  1. Presence of any clinical renal injury markets confirmed at the interval of not less than 3 months;
  2. Any markers of irreversible structural renal changes detected once by means of an intravital morphologic examination of the organ or imaging techniques;
  3. Reduction of the glomerular filtration rate (GFR) < 60 ml/min/ 1.73 sq. m during 3+ months regardless of the presence of other renal injury signs.


In 2007, the World Health Organization (WHO) considerably specified the category N18 (previously, this code was designated to chronic renal failure) of the International Classification of Diseases (ICD-10). In order to maintain the generally accepted diagnosis structure, it is advisable to indicate the chronic kidney disease diagnosis after the primary disease; in this case, a disease code is indicated according to the ICD by the primary disease.

If the etiology of renal function disorder is unclear, the main diagnosis can be indicated as chronic kidney disease coded by the category N18 (where N18.1 — chronic kidney disease, stage 1; N18.2 — chronic kidney disease, stage 2, etc.). 

CKD stages

ICD-10 code (as amended as of October 2007)**

ICD-10 description

1

N18.1

CKD, stage 1, kidney damage with normal or increased GFR (>90 ml/min)

2

N18.2

CKD, stage 2, kidney damage with mildly decreased GFR (60-89 ml/min)

3a

N18.3

CKD, stage 3, kidney damage with moderately decreased GFR (30-59 ml/min)

3b

4

N18.4

CKD, stage 4, kidney damage with severely decreased GFR (15-29 ml/min)

5

N18.5

CKD, stage 5, chronic uremia, end-stage kidney disease (including RRT cases (dialysis and transplantation)


 * - in order to specify CKD etiology, it is necessary to use the corresponding disease codes 

**- Code N18.9 is designated to unspecified CKD


Need to Detect Early-Stage CKD in Children

Children have their own list of diseases causing CKD:

1. Polycystic kidney disease or other genetic renal diseases in the family anamnesis.
2. Low birth weight.
3. Acute renal failure as a result of perinatal hypoxemia or other acute renal injuries.
4. Renal dysplasia or hypoplasia.
5. Urological abnormalities, especially obstructive uropathies.
6. Vesicoureteric reflux connected with repeated urinary tract infections and renal cicatrization.
7. Acute nephritis or nephrotic syndrome in the anamnesis.
8. Hemolytic-uremic syndrome in the anamnesis.
9. Schonlein-Henoch disease in the anamnesis.
10. Diabetes mellitus.
11. Systemic lupus erythematosus.
12. Hypertension in the anamnesis, in particular, as a result of renal artery or vein thrombosis in the perinatal period.

Children with impaired physical development (growth retardation, low body weight), rickets-like skeleton deformation, metabolic acidosis, early emerged anemia, polyuria, polydipsia, proteinuria, hypertension, impaired concentration function of the kidneys represent the CKD risk group, which requires thorough examinations of these patients and prescription of corrective and replacement therapy in order to slow down the CKD progression.

Congenital, hereditary and acquired renal diseases in children can potentially lead to unfavorable outcomes – chronic kidney disease (CKD) and CRF.

The need to detect CKD in children at the early stage is a socially important goal: the earlier the detection of CKD risk factors in children will be initiated, the larger number of people will remain healthy and employable. In addition, it will significantly reduce the risk of concomitant diseases in such children.