Kidneys: What’s the Big Deal?

Donal O’Donoghue  is a Consultant Renal Physician at Salford Royal and is Professor of Renal Medicine at the University of Manchester.shutterstock_141723022

Kidneys are amazing but so are the other vital organs. Disease of the kidney is no more important that disease of the brain or cardio-respiratory systems. Indeed one could argue it is less important because kidney disease is usually silent but it’s also common, harmful and yet treatable. The real reason however to notice the kidney function results is that they provide a window onto the functioning of the body. It’s a built-in early warning system.

Chronic kidney disease (CKD) is a more powerful predictor of vascular events than diabetes and the mortality of acute kidney injury (AKI) is responsible for over 12,000 preventable deaths in England each year. Although these two major categories of kidney disease are usually portrayed in different frames they should be considered together. CKD,  long-term kidney damage or  reduction in kidney function, is the largest risk factor of AKI , the sudden loss of function over hours or days , and although young people can often  recover fully from AKI that isn’t always the case in older patients. Therefore AKI is also frequent cause of CKD.

Half of those over 75 years will have some degree of kidney damage – indicated by either protein in the urine or reduced kidney filtration measured by serum creatinine. CKD is a vascular risk factor and picks out those who will benefit more from optimization of traditional risk factors – smoking cessation, hypertension, cholesterol and blood sugar control. AKI is one of the body’sresponses to acute illness, particularly sepsis. It complicates 15% of acute admissions and is now responsible for the largest year on year increase of all the major disease categories. Costs in England are over £1.2 Billion and, in one large acute trust, reducing the incidence of AKI by 10% resulted in the saving of 5000 bed days.

Reducing risk, early recognition and right response in kidney disease are not rocket science. It’s also not just about kidneys. CKD spells cardiac, kidney and diabetes – all three often occur together. They share the same determinants, risk factors and, in addition, some drugs put the kidneys at risk. AKI is a marker of severity of acute illness, whatever the setting, and is most common in older people with multimorbidity. CKD and AKI could not be easier to identify – it’s just simple blood and urine tests. Even small increases in serum creatinine or the presence of detectable proteinuria are important as they denote high risk. The response: good basic clinical care, medicines management and review when people become sick, maintaining hydration and nutrition and prompt diagnosis and treatment of sepsis are the cornerstones of reliable kidney care. Safeguard the kidney to protect the patient.

World Kidney Day is Thursday 13th March. For more details see their website.

Earlier this week Miles Witham blogged about kidney disease in older people, and why geriatricians should be involved.

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