Via practica 2/2015

Chronic kidney disease – role of nephrologist and general practitioner

Chronic kidney disease affects nearly one tenth of the population and is becoming not only a medical, but also socioeconomic problem. The best measure taken in order to slow down the epidemic of development of advanced disease stages is the implementation of screening programmes to search for patients with a pre-existing renal injury or to identify those who have risk factors for its development (e.g. hypertension, cardiovascular disease, diabetes mellitus or other metabolic disorders, risky medications etc.). New recommendations for assessment and treatment of chronic kidney disease focus not only on the assessment of renal function by means of glomerular filtration rate and the level of albuminuria, but emphasis is also placed on determining structural abnormalities in the renal parenchyma and identifying the cause of kidney disease. Based on meta-analyses of large trials, a scheme for determining the risk of progression of chronic kidney disease has been devised that recommends both the frequency of evaluations of renal parameters and the appropriateness of being followed up by a nephrologist in individual patient categories. Groups of patients with a low risk of progression can be followed up by general practitioners and in a longer time interval; patients with the highest risk should be followed up at least four times a year by a specialist, a nephrologist.

Keywords: chronic kidney disease, albuminuria, glomerular filtration rate.