Early Detection & Prevention/Progression of Chronic Kidney Disease (CKD)
Dr.Georgy K.Nainan DM, FISN, Sr.Consultant Nephrologist, PVSM & Lakeshore Hospitals, Cochin

Chronic Kidney Disease (CKD) is increasing globally and also in India especially with more awareness about renal diseases and with increasing number of diabetic patients. Chronic kidney disease can occur with minimal urinary abnormalities, normal blood urea, creatinine and only GFR estimation will be more predictive of the
chronic kidney disease. Urinary abnormalities, proteinuria and structural changes should warn us of chronic kidney disease. Of the many risk factors hypertension, diabetes and dyslipedimiatops the list. Uremia related risk factors are anemia, left ventricular hypertrophy, fluid over load and malnutrition. There is a close association between renal anemia and the relative risk of death or hospitalization. Renal anaemia correlates with poor out come and the risk factors have to be corrected at the earliest. Micro albuminuria is the earliest sign at which diabetic nephropathy can be detected clinically and there is a role for ARB / ACEI even in normotensive diabetic nephropathy patients. Optimal management of chronic kidney disease is known to slow down the progression. Dialysis comprises of the visible and expensive component of nephrology care and is only the tip of the iceberg. CKD patients if followed up for 5years 25% of them end up in death where as only 1.3% goes for renal replacement therapy as dialysis or kidney transplantation. Therefore early renal evaluation is very important in preventing the progression of the chronic kidney disease and from entering dialysis and needing transplantation and from cardio vascular death. The factors modifying the progression of the disease are : " Strict BP control ACE inhibitors, angiotensin II receptor blockers (ARBs) if indicated. " Timely treatment of CKD anaemia " Cholesterol and lipids control with statins " Diabetes control n Reduction of protein diet preferably vegetarian protein " Avoid nephrotoxic agents