Management of Chronic Renal Disease In Primary Care

Primary care professionals are essential for the care of chronic kidney disease. Many of the problems for the care of this disease overlap with those of diabetes and hypertension, so the early treatment of chronic kidney disease, before it becomes necessary referral to the best nephrologist in Delhi, can improve health outcomes for the patient. However, the numerous guidelines for the care of chronic kidney disease, sometimes in the contradiction between them, they can make it difficult to try to understand the disease and provide adequate care. This can be especially true for primary care professionals who are in charge of managing a wide range of the spectrum of diseases.

Early treatment of chronic kidney disease can improve the results of the patient's health.

Management of Chronic Renal Disease In Primary Care

1. About chronic kidney disease

The kidneys regulate the composition and volume of blood, eliminate waste metabolic in the urine and help control the acid/base balance in the body.

They produce erythropoietin, a hormone necessary for the synthesis of red blood cells, and they activate the vitamin D necessary for the absorption of calcium and the health of the bones.

Chronic kidney disease is detected and monitored by nephrologist in Delhi using two tests:

• Blood test or analysis of estimated glomerular filtration rate (Estimated glomerular filtration rate-eGFR)
• The urine albumin to creatinine ratio test in the urine (Urine Albumin-to-Creatinine Ratio-UACR)

Chronic kidney disease is usually a progressive disease.

It is defined by:

• decreased renal function, ie an eGFR of <60 mL / min / 1.73 m2 for a period> of 3 months

OR

• evidence of kidney injury, including persistent albuminuria, that is, a rate of albumin in the urine of ≥ 30 mg per gram of creatinine in urine for a period > 3 months Renal failure is typically defined as an eGFR <15 mL/min/ 1.73 m2.

The key issues in the management of chronic kidney disease are:

• ensure the correct etiology
• apply the appropriate treatment
• monitor renal function to the patient
• screening tests for complications of kidney disease
• educate the patient

Not all patients with a decrease in eGFR or low-grade albuminuria will progress to failure renal.

Not all patients with a decrease in eGFR or low-grade albuminuria will progress to kidney failure. It is important to identify patients who have a high risk that the disease advances to stop that progress.

In general, the progression of the disease is often associated with:

• high concentrations of albuminuria,
• progressive decrease of the eGFR, and
• poorly controlled blood pressure.

However, the lack of precision of biomarkers for renal function and injury, as well as the variability in the progression of the disease among patients, suggests that the risk of progression must incorporate a variety of clinical characteristics, which include the results of the eGFR and UACR tests, the speed of progression and the blood pressure. Until there are validated algorithms, kidney specialist in Delhi is warned be careful trying to predict the forecast based on a single measurement of a particular biomarker.

It is important to identify the patients who have a high risk of the disease breakthrough to stop that progress.

The key components to slow the progression of chronic kidney disease, suggested by top nephrologist in Delhi are:

• control blood pressure (with angiotensin-converting enzyme inhibitors) or angiotensin receptor blockers)
• reduce albuminuria
• control diabetes
• avoid acute kidney injury