Don’t neglect the kidneys

We usually focus on the heart and forget about the kidneys. Prof. Dr. Christoph Wanner, Head of Nephrology at Würzburg University Hospital and President of ERA-EDTA, explains how important and easy it is to recognise the first signs of kidney damage. He also gives hope as new therapy options can stop the progression of the disease.

Prof. Dr. Christoph Wanner: There may be several reasons, such as (a) the change in demography and longevity, (b) the rising tide of people with type 2 diabetes mellitus and hypertension as well as (c) processed foods and obesity.

Increasing levels of albumin in the urine are the first sign of kidney damage and precede the decline in kidney function. A simple laboratory test, ideally a urine albumin-to-creatinine ratio (UACR) measurement in a spot urine sample would be sufficient in individuals at risk.

Do the kidney tests (UACR and eGFR) once per year. Surveys and cohort studies indicate that more than two-thousand-year-old wisdom, “Test your Heart and Kidneys“ (referenced to the Bible), has been neglected in recent years. We often focus on the heart and forget the kidneys. A change in focus is necessary.

The rise in albumin in the urine can be found many years before kidney damage becomes overt in individuals with diabetes mellitus and elevated blood pressure. It is never too early.

Everyone above the age of 50 should know her/his ABCDE profile which stands for Albuminuria, Blood pressure, Cholesterol, Diabetes, Estimated Glomerular Filtration rate (eGFR). The A and E profiles should be re-evaluated at annual intervals in individuals at risk. The profile also reflects patients’ cardiovascular risk and can be used for cardiovascular risk assessment even in healthy individuals.

Specialists and family doctors recently got excited about the possibility to offer new interventions to their patients, effective measures beyond lifestyle consulting. These interventions are new medicines, which can stabilize the progression of kidney disease on the road to kidney failure.

World Kidney Day is a unique opportunity where Social Media Channels reach a wide population and media are taking up and spreading the message. European and international societies disseminate information to national healthcare professionals who can inform individuals at risk through local press activities. Many specialists can be reached during this day and associated activities.

Disease awareness by diagnosing kidney disease through albuminuria testing is key. Healthcare systems, governments, or payers, should reimburse the kidney test, especially the albuminuria component. So far, it is not included in screening programs in every nation in Europe.