Adnkronos (Adnkronos) – "At this historic moment, we need to implement a pathway in nephrology, for chronic kidney disease, but also for systemic kidney disease, that allows for diagnosis in the shortest possible time. We must avoid the problem of 'late referrals,' that is, patients being taken care of late within the nephrology network, both at the local and hospital levels, at the first, second, and third levels.
A delayed diagnosis and, consequently, a delayed treatment are a major problem. The nephrology network must function effectively, optimizing rapid patient admission to be able to act when the timing is right to reduce kidney damage." This was stated by Gian Luigi Zaza, director of the Nephrology, Dialysis, and Transplant Unit at the Policlinico Umberto I in Rome, at the closing of 'CL3AR' in Piazza Mastai in the capital. CL3AR is Sobi Italia's awareness campaign, sponsored by the DDD ETS project patient association and the scientific societies FIR, SINEPE, and SIP, to increase awareness of kidney health and rare kidney diseases in adults and children and promote early diagnosis.
“To improve the timeliness of diagnosis and to raise awareness of kidney disease,” Zaza continues, “it is important to activate an entire system that starts with correctly informing patients about the consequences of not only an incorrect, but also a delayed diagnosis.
They must be informed of the need to enter the local and central nephrology network, therefore hospital, as soon as possible and of the new diagnostic options and the new therapeutic pipelines that are currently being developed, which represent a significant paradigm shift. We have diagnostic tools at our disposal that were not available until a few years ago,” the expert emphasizes. “Compared to the past, when the diagnosis is early and well-made, we have much more effective tools for both adult and pediatric patients.”
In addition to moving "toward increasingly personalized and molecular medicine," Zaza emphasizes, "we are also learning to work on specific therapeutic targets, for example, using drugs that act on the complement system and newly developed SGLT2 inhibitors. The earlier the diagnosis is made, the sooner we can begin treatment in the early stages of the disease, and we have the opportunity to slow the progression of kidney damage in both adults and pediatric patients by decades. It is extremely important," he emphasizes, "to change pace and include the patient as soon as possible in an effective nephrological diagnostic and treatment network."
"Kidney diseases are often asymptomatic, showing no signs of their presence," explains the nephrologist. "It is therefore necessary to conduct population screening and have affordable, effective, and population-wide predictive diagnostic tools. One of these is certainly the ACR (urinary albumin/creatinine ratio), which assesses proteinuria and the presence of urinary abnormalities. It is easily performed: a urine test or simple, inexpensive blood tests such as creatinine measurement and glomerular filtration rate assessment are sufficient. These tests should be performed periodically, not only in high-risk populations, such as heart patients, diabetics, those with metabolic disorders, and the elderly."
In this regard, "we are activating many programs together with occupational medicine and hygiene," Zaza specifies, "to provide direct and indirect population screening that allows us to detect chronic damage early." Also crucial in this regard is the "role of information, using tools such as the internet and all social media platforms. In a few years, these diseases will represent one of the leading causes of mortality in the population," the expert reiterates. "The prevalence of chronic kidney disease is progressively increasing and in 10-15 years, it will reach the top five positions as a population-wide cause of morbidity. One in 10 individuals with varying degrees of kidney damage has nephrological problems that need to be investigated. Studying these diseases within population-based screening programs is highly recommended," he concludes.
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