A review of important tips on chronic kidney disease for 21st century general practitioners

One of the major goals of the International Society of Nephrology is prevention of chronic kidney disease. It is a slow-burning, unrelenting disorder that is largely asymptomatic in the very early stages thus leaving room for silent progression to end stage if left unchecked. Sub-optimal knowledge of the disease, non-screening for renal markers and late referral are among physician-related factors that hinder patients from accessing early intervention by nephrologists. Here, we draw attention of General Practitioners to current principles in early identification of chronic kidney disease. It is a multi-systemic disease capable of mimicking other organ-system disorders hence requires a high index of suspicion. The updated Kidney Disease Outcome Quality Initiative definition, diagnosis and staging of chronic kidney disease has improved early detection, prevention and retardation of the disease among population at risk. Routine renal function and structure evaluation should be conducted for all new patients presenting for care, be it out-patient or admission. Serum creatinine and albuminuria are the two most important markers required for early diagnosis and staging of CKD; unlike previously thought, urea does not rank high among markers of chronic kidney disease. History of nocturia, can be an important early pointer to chronic kidney disease, especially among population at risk. Presence of normal blood pressure, normal urine volume, absence of body swelling and sonographically normal renal sizes do not exclude chronic kidney disease where serum creatinine is elevated. Improved knowledge of chronic kidney disease among non-nephrology physicians can significantly reduce the global burden of the disease.