The Jiménez Díaz Foundation University Hospital recently hosted a webinar on chronic kidney disease with the aim of updating specialists in family and community medicine on new advances in the diagnosis and treatment of this pathology. The importance of the forum lies in the fact that chronic renal failure is expected to become the sixth leading cause of death in Spain in 2040 and the second, after Alzheimer, in 2100.
The chronic kidney disease is a kidney condition that lasts more than three months and increases the risk of premature death or needing substitution of renal function by dialysis and transplantation, the first of these two results being the most frequent, as pointed out by Dr. Alberto Ortiz Arduan, head of the nephrology and hypertension department of the Jiménez Díaz Foundation.
Reversing this situation requires redoubled efforts in prevention and early detection. In this last area, the specialist recalls three fundamental diagnostic tools: the blood test with measurement of creatinine, which “allows calculation of the glomerular filtration rate, to know the percentage of renal function”; urinalysis with albumin assay, which “allows the disease to be detected before the loss of renal function and therefore to intervene earlier”; and ultrasound of the kidneys, which “facilitates the diagnosis of diseases such as polycystic kidney disease, before albumin appears in the urine or kidney function is lost.”
Prevention, a key element
Given the “alarming incidence data”, prevention is the other key element to work “from now on” to lessen the impact of chronic kidney disease, insists Dr. Ortiz. For this reason, he recommends knowing the kidney health of family members, high blood pressure problemselevated creatinine or albumin or blood urine records since, if there is a family history, it will be advisable to perform a glomerular filtration rate and tests to assess blood pressure values and rule out the presence albumin in the urine.
Others prevention basics provided by the nephrologist consist of limit salt intake, maintain a healthy weight “so that diabetes and blood pressure are controlled as well as possible and that the kidneys are not overloaded”, exercise regularly and “eat from the market, not from the supermarket; that is, buy raw products, without the additives that are added to processed foods – especially salt and phosphates – and cook them at home.
Kidney problems are also triggered by other types of pathologies such as Diabetes and glomerular diseases. Additionally, Dr. Ortiz explains that “there is some doubt as to whether hypertension is the cause or consequence of kidney disease, or both,” but points out that “in all cases, controlling hypertension improves renal prognosis“.
In the Nephrology and Hypertension Department of the Jiménez Díaz Foundation, the most common kidney pathology is that caused by diabetes, which, according to its manager, is the one with the worst prognosis: “That’s why Early detection is essential in all diabetic patients.“.
Treatments to relieve kidney conditions
to exist two different stages chronic kidney disease and the first occurs before you need to replace the overall function of the kidneys. Thus, the specialist indicates that “in this phase, the focus must be on protecting the kidneys so that they do not need dialysis and, more importantly, on protecting the heart so that it does not die. not or has no prematurely irreversible sequelae”.
For it, drugs are prescribed to block angiotensin and SGLT2 inhibitors, since “both reduce the loss of albumin and protein in the urine, preserve the anti-aging protein Klotho, delay the deterioration of kidney function and protect the heart”, he specifies.
The The second stage begins when the overall function of the kidneys needs to be replaced. In this context, there is three options: hemodialysis, peritoneal dialysis or transplant, which can be used sequentially. Likewise, Dr. Ortiz points out, at any time it may be necessary to replace partial functions that the kidneys are gradually losing, “such as fighting anemia with erythropoietin, maintaining bone health with calcitriol, giving bicarbonate by mouth when the kidneys do not produce it in sufficient quantity or maintain normal levels of phosphates or potassium with binders of these electrolytes”.