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Kidney diseases Prevention

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Prevention

Chronic kidney disease

Prevention of chronic kidney disease is possible and early treatment can slow progression and reduce cardiovascular risk.

Preventive measures in primary care medicine:

• Encourage people with family histories to take action to prevent hypertension and diabetes:
  • Lose weight if overweight.
  • Reduce salt intake.
  • Increase fruit, vegetable, low fat dairy and decrease saturated fat and alcohol consumption.
  • Exercise 30 minutes a day most days of the week.
• Treat patients with diabetes or hypertension and chronic kidney disease with an ACE inhibitor or angiotensin receptor blocker.
• Target blood pressure: < 130/85 mmHg or even lower.
• Control blood glucose levels carefully in patients with diabetes and counsel on diet all patients with chronic kidney disease.
• Treat other traditional cardiovascular risk factors, particularly smoking and hypecholesterolemia.
• Avoid potentially nephrotoxic medications.
• Obtain consultation with a nephrologist, although much of the ongoing care can be given by primary care providers.

Nephrolithiasis

Many patients with nephrolithiasis have remediable metabolic disorders that cause stones and can be detected by chemical analyses of serum and urine. Therefore, prevention of nephrolithiasis aims at treatment of metabolic disorders such as hyperuricosuria, primary hyperparathyroidism, hyperoxaluria, hypocitraturia, and cystinuria.

Calcium stones:

1. In all patients increase fluid intake to yield an output of at least 2 liters of urine per day.
2. In the patient with hypercalciuria:
   • Dietary restriction of protein, oxalate and sodium; no restriction of dietary calcium
   • Medication: thiazides, usually given with potassium citrate; amiloride
3. In the patient with hypocitraturia:
   • Dietary restriction of protein and sodium.
   • Potassium citrate supplementation or sodium citrate, if not tolerated
4. In the patient with hyperoxaluria:
   • Dietary restriction of oxalate
5. In the patient with hyperuricosuria:
   • Dietary restriction of purine (i.e. protein)
   • Allopurinol

Uric acid stones

1. Increasing fluid intake is less important for the prevention of uric acid stones than calcium stones.
2. In the patient with low urinary pH level:
   • Dietary restriction of protein and sodium
   • Alkalinization of urine with potassium citrate or sodium citrate, if not tolerated
3. In the patient with hyperuricosuria:
   • Dietary restriction of protein and sodium
   • Alkalinization of urine with potassium citrate if urinary pH level is low
   • Allopurinol in selected situations

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