John feeHally, president-elect of the International Society of Nephrology, came to India, carrying two important messages. To the government, he said: Standardise the diagnostic testing for serum creatinine (an important measure of kidney function). To the people of the country he said: Test yourselves periodically for albumin in the urine.
Both messages hinged on the most important item on the agenda of the Society: Prevention. “We have the opportunity now, as never before to pick up kidney disease early. We can stop some of them from ever moving to kidney failure and the treatment is cheap, Dr. feeHally told presspersons here on Wednesday, at a meeting organised by the Balaji Medical and Educational Trust. “The real success,” he said, “would be to stop people getting kidney failure.”
For this to happen, the doctors (non –nephrologists) and nurses would have to be informed, just as much as the general public has to be. In the UK, for instance, with increased stress on prevention, the trend of increasing number of new people reporting with kidney disease increasing over 20 years had been staunched over the last three years, he added.
General practitioners must look out for patients who are hypertensive, diabetic, or have a family history of kidney disease, as chronic kidney disease can be without symptoms. Aggressive control of both high blood pressure and diabetes are essential to prevent chronic kidney disease. Submitting oneself to regular urine albumin tests is important. “Good prevention, good detection and cheap treatment are all making a difference across the world,” Dr. feeHally reiterated.
Rajan Ravichandran, managing trustee of Balaji Medical and Educational Trust, said nephrologists had appealed to the Government of India and the Indian Society of Nephrology to lay down standard for the lab measure of serum creatinine. “We get various levels at different labs. The danger with this is that we might start treating a patient with no disease, or worse still, miss someone who has chronic kidney disease.” Minimum infrastructure and certification by a central body must be made mandatory for all diagnostic labs, he added.
He also made a case for evolving an Indian standard of diagnostic values that would be more appropriate in detecting kidney disease early. Currently, only Western standards are being used as diagnostic criteria, though clearly Indians as an ethnic group have a high incidence of diabetes and hypertension, both of which are known to be key causative agents of kidney disease. Good control of diabetes and blood pressure, having a healthy lifestyle and diet modifications are important, Dr. Ravichandran added. More information is available on www.sugarbp.org
