Screening for serious kidney disease

(03.07.2009)The combination of two common medical tests can improve a doctor’s ability to predict which patients will develop serious kidney disease, a research team led by the Norwegian University of Science and Technology (NTNU) reports in a recent issue of the Journal of the American Society of Nephrology.

Journal of the American Society of Nephrology

The finding also has significance for cardiovascular disease, which often goes hand in hand with chronic kidney disease.

Kidneys play an important role in regulating the body’s fluids and salt balance, and cleanse the blood of waste products. More than ten percent of the world's population has a chronic kidney condition, which means that the kidneys gradually stop working. In spite of this widespread prevalence, relatively few individuals develop renal failure severe enough to require dialysis or transplantation.

Difficult to detect – until now
The catch has always been to figure out which of the patients with chronic kidney disease are likely to go on to the more severe and debilitating version of the illness, so that doctors can intervene early to try to prevent it.

A team of researchers led by Stein I Hallan at NTNU’s Faculty of Medicine has found that using two common medical tests – measuring creatinine in the blood and albumin in the urine – improves a doctor’s ability to detect early stages of serious kidney failure.

The researchers used data from the population-based Nord-Trøndelag Health Study (HUNT 2, 1995-1997) to examine information from 65,589 adults. Of these, 124 progressed to end-stage renal disease after 10.3 years.

Creatinine and albumin together as predictors
“High creatinine in the blood shows that the kidneys are doing a poor job of cleansing the blood, and means that kidney disease is already advanced. High albumin in the urine gives a measure of how rapidly kidney disease is developing”, says Hallan.

Hallan emphasized that both tests should be used together to assess the future risk of kidney failure. He thinks the method will be an effective tool in the treatment of this patient group.

In the United States alone, 785 000 people are expected to develop severe kidney failure in 2020, with treatment estimated to cost upwards of USD 32 billion annually. Doctors and researchers are therefore eager to find ways to make a diagnosis as early as possible.

Important for the heart and the cardiovascular system
Chronic kidney disease is also an indicator of high risk for cardiovascular disease.

Nephrology Medical researchers at St. Olavs Hospital in Trondheim and NTNU have previously shown that the combination of the two tests is a very useful tool for assessing future cardiovascular disease risk, especially in older patients.

“Chronic kidney disease and cardiovascular disease often go hand in hand and should always be evaluated with a combination of blood and urine samples,” Hallan says.

Other cooperating researchers for the study came from Ruperto Carola University in Heidelberg and the University of Regensburg, both in Germany. The study has been published in the Journal of the American Society of Nephrology.

More about HUNT

The Nord-Trøndelag health study (HUNT) is one of the largest health studies ever undertaken. It is comprised of a unique database of personal and family medical histories that were collected during three intensive studies. Today, HUNT is a database with information about approximately 120,000 individuals, where family data and individual data can be linked to national health registries.