A significant number of fellowships were undertaken in selected developed centers within the fellows own region. This article complements this Isepamicin initiative by focusing on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with preexisting kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of comorbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to KLF4 antibody avoid or delay dialysis or kidney transplantation. Political efforts are needed to disseminate the preventive approach. While national policies and strategies for noncommunicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals, and policy makers. implies intervening before health effects occur in an effort to prevent the onset of illness or injury before the disease process begins, (2) suggests preventive measures that lead to early diagnosis and prompt treatment of a disease to prevent more severe problems developing and includes screening to identify diseases in the earliest stages, and (3) indicates managing disease after it is well established to control disease progression and the emergence of more severe complications, which is often by means of targeted measures such as pharmacotherapy, rehabilitation, and screening for and management of complications. These definitions have important bearing in the prevention and management of the CKD, and accurate identification of risk factors that cause CKD or lead to faster progression to renal failure as shown in Figure 1 are relevant in health policy decisions and health education and awareness related to CKD.12 Open in a separate window Figure 1. Overview of the preventive measures in chronic kidney disease to highlight the similarities and distinctions pertaining to primary, secondary, and tertiary preventive measures and their intended goals. Primary prevention of CKD The incidence (new cases) and prevalence (cumulative preexisting cases) of CKD have been rising worldwide.13 This primary level of prevention requires awareness of modifiable CKD risk factors and efforts to focus health care resources on those patients who are at Isepamicin the highest risk of developing new onset or de novo CKD. Measures to achieve effective primary prevention should focus on the 2 2 leading risk factors for CKD including diabetes mellitus and hypertension. Evidence suggests that an initial mechanism of injury is renal hyperfiltration with seemingly elevated glomerular filtration rate (GFR), above normal ranges. This is often the result of glomerular hypertension that is often seen in patients with obesity or diabetes mellitus, but it can also occur after a high dietary protein intake.8 Other CKD risk factors include polycystic kidneys or other congenital or acquired structural anomalies of the kidney and urinary tracts, primary glomerulonephritis, exposure to nephrotoxic substances or medications (such as nonsteroidal anti-inflammatory drugs), having 1 single kidney, eg, Isepamicin solitary kidney after cancer nephrectomy, high dietary salt intake, inadequate hydration with recurrent volume depletion, heat stress, exposure to pesticides and heavy metals (as has been speculated as the main cause of Mesoamerican Nephropathy), and Isepamicin possibly high protein intake in those at higher risk of CKD.8 Among nonmodifiable risk factors are advancing age and genetic factors such as apolipoprotein 1 (APOL1) gene that is mostly encountered in those with sub-Saharan African ethnicity, especially among African Americans. Certain disease states may cause de novo CKD, such as cardiovascular and atheroembolic diseases (also known as secondary cardiorenal syndrome) and liver diseases (hepatorenal syndrome). Table 1 shows some of the.
A significant number of fellowships were undertaken in selected developed centers within the fellows own region
