Screening of nephropathies within preventive care

Chronic kidney diseases (CKD) affect a substantial portion of the population and are defined as abnormalities of the renal structure

or function present for more than three months and affecting health. Diabetic nephropathy, hypertensive (ischaemic) nephropathy,

glomerular diseases, and hereditary nephropathies are among the most frequent chronic kidney diseases. Fifty percent of patients

having end-stage chronic kidney disease are unaware of their condition and/or are not followed in nephrology outpatient services;

they are offered neither kidney transplantation nor peritoneal dialysis, and haemodialysis treatment of these patients is associated

with higher morbidity and mortality rates. Since autumn 2016, there have been several changes in the wording of the Ministry of

Health’s Decree on surveillance care and of that on preventive medical check-ups concerning kidney disease. Quadrennial preventive

check-ups are newly intended for patients with diabetes, hypertension or cardiovascular complications who are older than 50 years

of age; the check-up includes the calculation of estimated glomerular filtration rate (eGFR) based on serum creatinine. Surveillance

by general practitioners, nephrologists or other specialists is then necessary for patients with an eGFR < 0.5 ml/s, proteinuria higher

than 1 g/24 hours, microscopic haematuria of renal origin, chronic glomerulonephritis, polycystic kidney degeneration or congenital

kidney disease. Implementation of these changes into clinical practice is intended to ensure early referral of patients to nephrology

outpatient services with the aim to slow down the progression of chronic nephropathies, increase the availability of kidney transplantation

without the need for dialysis treatment, and significantly reduce the initiation of dialysis treatment in unprepared patients.

Keywords: chronic kidney disease, glomerular filtration, proteinuria, dialysis