Chronic Kidney Disease аs a Common Medical Problem

The risk of chronic kidney disease, as well as other "silent killers" – diabetes, hypertension, cancer, is that patients for a long time do not experience changes in well-being, leading to late detection of chronic kidney disease, the renal protection therapy has been exhausted. The peculiarity of the problem of chronic kidney disease is the predominance of secondary nephropathies, in connection with patients for a long period of time, there are therapists and specialists –"mineralogie", and the cases of chronic kidney disease as secondary diseases are almost not included in official statistics. The concept of chronic kidney disease does not contradict the priority of the nosological approach in modern medicine. On the contrary, it is intended to provide timely referral of patients with signs of kidney damage to the nephrologist, who conducts a differential diagnosis and establishes a nosological diagnosis, assess the risk of progression, determines etiotropic and pathogenetic therapy. At the same time, the value of the philosophy of chronic kidney disease is that it allows even in the case when the nosological diagnosis is still not fully installed, to plan and carry out activities of secondary prevention, acting on the universal mechanisms of progression of chronic kidney disease to preserve renal function and reduce the risk of cardiovascular complications. Population-based epidemiological studies conducted in the last decade give an idea of the magnitude of the problem of chronic kidney disease. The results of a study of prognosis of chronic kidney disease (Chronic Kidney Disease Prognosis Consortium) showed a significant and independent relationship of estimated GFR and albuminuria with total and cardiovascular mortality, progression of chronic kidney disease and the risk of developing acute kidney injury. Chronic kidney disease is recognized as an independent risk factor for cardiovascular disease and an equivalent of coronary heart disease risk of cardiovascular complications. No doubt the value of microalbuminuria as one of the most important markers of high risk of developing cardiovascular disease and kidney failure. The prevalence of chronic kidney disease is high and is not inferior to the prevalence of such socially significant diseases as diabetes, hypertension, heart failure. In the UK automated screening 10 975 patient records observed by General practitioners revealed 492 cases of chronic kidney disease with GFR < 60 ml/min/1.73 m2 (5.7%). According to the studies conducted on different continents in countries with different ethnic composition and economic development, the signs of chronic kidney disease have been reported in 12-18% of the population, and most adverse chronic kidney disease stages 3-5 – have a 5.9-8.1% of residents (in Japan, to 18.7%). We can assume that every tenth inhabitant of the Earth has signs of chronic kidney disease. Information about nosological composition of the chronic kidney disease require clarification, because population studies usually do not involve a detailed nephrological examinations, and created by currently the registers do not include chronic kidney disease patients in the early stages. In addition, there are differences between countries in the prevalence of renal diseases of different nature (high frequency of urolithiasis in countries of the Middle East, IgA nephropathy in Japan, kidney disease of an infectious nature in developing countries, etc.).