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Prof. Dr. Christoph Wanner, Head of Nephrology at the University Hospital of Würzburg and President of the European Society of Nephrology (ERA)

Don’t neglect the kidneys

Prof. Wanner, how do you explain the predicted high increase in kidney disease?

Prof. Dr. Christoph Wanner: There may be several reasons, such as (a) the change in demography and longevity, (b) the rising tide of people with type 2 diabetes mellitus and hypertension as well as (c) processed foods and obesity.

Could the expected high increase be stopped by screening for microalbuminuria, for example?

Increasing levels of albumin in the urine are the first sign of kidney damage and precede the decline in kidney function. A simple laboratory test, ideally a urine albumin-to-creatinine ratio (UACR) measurement in a spot urine sample would be sufficient in individuals at risk.

How should diagnostics be changed to detect kidney damage at an early stage even in supposedly healthy patients aged 50+?

Do the kidney tests (UACR and eGFR) once per year. Surveys and cohort studies indicate that more than two-thousand-year-old wisdom, “Test your Heart and Kidneys“ (referenced to the Bible), has been neglected in recent years. We often focus on the heart and forget the kidneys. A change in focus is necessary.

How early can UACR detect kidney damage compared to eGFR?

The rise in albumin in the urine can be found many years before kidney damage becomes overt in individuals with diabetes mellitus and elevated blood pressure. It is never too early.

What are your top pieces of advice to prevent kidney problems before the first symptoms occur?

Everyone above the age of 50 should know her/his ABCDE profile which stands for Albuminuria, Blood pressure, Cholesterol, Diabetes, Estimated Glomerular Filtration rate (eGFR). The A and E profiles should be re-evaluated at annual intervals in individuals at risk. The profile also reflects patients’ cardiovascular risk and can be used for cardiovascular risk assessment even in healthy individuals.

How do I find out which treatment option is best for me?

Specialists and family doctors recently got excited about the possibility to offer new interventions to their patients, effective measures beyond lifestyle consulting. These interventions are new medicines, which can stabilize the progression of kidney disease on the road to kidney failure.

What opportunities do you see in World Kidney Day to make people aware of the topic?

World Kidney Day is a unique opportunity where Social Media Channels reach a wide population and media are taking up and spreading the message. European and international societies disseminate information to national healthcare professionals who can inform individuals at risk through local press activities. Many specialists can be reached during this day and associated activities.

What policy changes would you like to see soon to help stop the predicted increase in kidney disease?

Disease awareness by diagnosing kidney disease through albuminuria testing is key. Healthcare systems, governments, or payers, should reimburse the kidney test, especially the albuminuria component. So far, it is not included in screening programs in every nation in Europe.