12^th European Congress on Nephrology, Internal Medicine and Kidney Diseases April 29-30, 2024 Paris, France

Diagnostic tools for kidney diseases have evolved significantly over the years, with advancements in technology and research. One of the latest developments is the use of novel diagnostic tools such as biomarkers, imaging techniques, and genetic testing. These tools can help identify kidney diseases earlier, assess disease severity, and predict the risk of disease progression. For example, the use of urine and blood biomarkers can provide insights into the function of the kidneys, while imaging techniques like magnetic resonance imaging (MRI) and computed tomography (CT) can detect structural abnormalities. Additionally, genetic testing can identify inherited kidney diseases and inform personalized treatment plans. These novel diagnostic tools have the potential to improve outcomes for patients with kidney diseases.

There are several therapeutic options available for kidney diseases, ranging from lifestyle modifications to medication and surgery. Lifestyle changes such as maintaining a healthy diet, exercising regularly, and quitting smoking can help prevent and manage kidney diseases. Medications like angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can control high blood pressure and protect the kidneys. In more severe cases, dialysis or kidney transplant may be necessary. Researchers are also exploring new therapeutic options, such as stem cell therapy and gene therapy, which have shown promising results in early studies. Overall, early detection and intervention, coupled with personalized treatment plans, can significantly improve outcomes for patients with kidney diseases.

Chronic kidney disease (CKD) is a global public health issue affecting millions of people worldwide. The prevalence of CKD varies by region, with higher rates reported in low- and middle-income countries. Diabetes and hypertension are the leading causes of CKD, accounting for approximately 50% of cases. Other risk factors include smoking, obesity, and family history of kidney disease. CKD is associated with an increased risk of cardiovascular disease and premature death. Early detection and management of CKD are crucial to preventing disease progression and reducing the risk of complications. Public health efforts focused on addressing modifiable risk factors and improving access to care can help mitigate the burden of CKD on individuals and society.

Kidney diseases and cardiovascular health are closely linked, with kidney diseases increasing the risk of cardiovascular disease (CVD) and vice versa. Chronic kidney disease (CKD) is a significant risk factor for CVD, with CKD patients being more likely to die from CVD than to develop end-stage kidney disease. Conversely, CVD can lead to kidney damage and CKD. Common risk factors for both kidney diseases and CVD include diabetes, hypertension, and smoking. Management of modifiable risk factors, including control of blood pressure and blood glucose levels, can help prevent both kidney diseases and CVD. Therefore, it is important to address kidney and cardiovascular health together to improve outcomes for patients.

Chronic kidney disease (CKD) can have a significant impact on bone health, leading to increased risk of fractures and osteoporosis. CKD-Mineral and Bone Disorder (CKD-MBD) is a systemic disorder characterized by abnormalities in bone metabolism and mineral homeostasis. Patients with CKD-MBD often have low levels of vitamin D and calcium, leading to bone loss and increased risk of fractures. Treatment options for CKD-MBD include vitamin D and calcium supplementation, medications that regulate phosphate levels, and dialysis. Management of CKD-MBD is crucial to prevent fractures and improve quality of life for patients with CKD.

Hemodialysis and peritoneal dialysis are two common techniques used for the treatment of end-stage kidney disease. Hemodialysis involves the use of a machine to filter blood through a dialyzer, while peritoneal dialysis involves the use of the patient's own peritoneum as a dialysis membrane. Hemodialysis is usually performed in a hospital or dialysis center, while peritoneal dialysis can be done at home. Both techniques have benefits and drawbacks, and the choice of dialysis modality depends on patient preference, medical history, and other factors. Overall, both hemodialysis and peritoneal dialysis are effective treatment options that can improve outcomes for patients with end-stage kidney disease.

Renal transplantation is the preferred treatment for end-stage kidney disease, offering patients improved quality of life and increased survival rates compared to dialysis. However, to prevent rejection of the transplanted kidney, patients require lifelong immunosuppressive therapy. Immunosuppressive medications such as calcineurin inhibitors, corticosteroids, and antimetabolites can effectively prevent rejection, but can also increase the risk of infections, malignancies, and other complications. Research is ongoing to identify new immunosuppressive strategies with fewer side effects. Additionally, personalized medicine approaches, including pharmacogenomics, may help optimize immunosuppressive therapy for individual patients. Overall, renal transplantation remains a life-saving option for patients with end-stage kidney disease, and the management of immunosuppression is crucial to ensure long-term graft survival.

Glomerular diseases are a group of conditions that affect the glomeruli, the tiny filters in the kidneys that remove waste from the blood. These diseases can cause proteinuria, or the presence of excess protein in the urine. Management of proteinuria is an essential aspect of the treatment of glomerular diseases, as it can indicate disease progression and is associated with increased risk of cardiovascular events and kidney failure. Treatment options include medications to lower blood pressure, reduce proteinuria, and prevent further kidney damage. Additionally, lifestyle modifications such as a low-protein diet and regular exercise can also help manage proteinuria in patients with glomerular diseases.

Electrolyte and acid-base balance are essential functions of the kidneys. Chronic kidney disease (CKD) can lead to imbalances in electrolytes such as sodium, potassium, and calcium, which can result in symptoms such as muscle weakness, fatigue, and arrhythmias. Additionally, CKD can affect acid-base balance, leading to metabolic acidosis. Management of electrolyte and acid-base imbalances in CKD involves monitoring of serum electrolyte and acid-base levels, and adjustment of medications and diet to prevent further imbalances. Patients with severe electrolyte imbalances may require hospitalization and intravenous electrolyte replacement therapy. Maintaining electrolyte and acid-base balance is crucial in preventing complications and improving outcomes for patients with kidney disease.

Diabetic nephropathy is a complication of diabetes that affects the kidneys, leading to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Management of diabetic nephropathy involves strict control of blood glucose levels, as well as blood pressure control and use of medications to reduce proteinuria and slow the progression of CKD. Lifestyle modifications, including a healthy diet and regular exercise, can also help manage diabetic nephropathy. In advanced cases, dialysis or kidney transplantation may be necessary. Prevention of diabetic nephropathy is crucial, and early detection and management of risk factors such as hyperglycemia and hypertension can help reduce the risk of kidney damage in patients with diabetes

Acute kidney injury (AKI) is a sudden and often reversible loss of kidney function that can result from a variety of causes, including infections, medications, and reduced blood flow to the kidneys. Treatment of AKI includes identifying and treating the underlying cause, as well as providing supportive care such as fluid management and electrolyte replacement. In severe cases, renal replacement therapy (RRT), such as hemodialysis or continuous renal replacement therapy (CRRT), may be necessary to replace the lost kidney function. RRT can also help manage complications such as electrolyte imbalances and fluid overload. Early recognition and management of AKI are crucial to prevent irreversible kidney damage and improve outcomes for patients.

Autoimmune kidney diseases, such as lupus nephritis and anti-glomerular basement membrane (GBM) disease, occur when the immune system mistakenly attacks the kidneys, leading to inflammation and damage. Management of autoimmune kidney diseases involves suppressing the immune system to reduce inflammation and prevent further kidney damage. This can be achieved through the use of immunosuppressive medications such as corticosteroids, cyclophosphamide, and mycophenolate mofetil. In severe cases, plasmapheresis or intravenous immunoglobulin (IVIG) may also be used to remove harmful antibodies from the blood. Regular monitoring of kidney function and urine protein levels is essential in managing autoimmune kidney diseases and preventing disease progression.

Hypertension, or high blood pressure, is a common complication of kidney disease and a major risk factor for the development and progression of chronic kidney disease (CKD). Management of hypertension in kidney disease involves blood pressure control through lifestyle modifications and medication therapy. Lifestyle modifications include weight loss, regular exercise, and a low-sodium diet. Medications commonly used to manage hypertension in kidney disease include angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs), which also have renal-protective effects. Regular monitoring of blood pressure and kidney function is crucial to prevent complications and improve outcomes for patients with kidney disease and hypertension.

Pediatric nephrology is the branch of medicine that deals with the diagnosis and management of kidney diseases in children. Kidney diseases in children can range from congenital anomalies of the kidney and urinary tract (CAKUT) to inherited kidney diseases, such as polycystic kidney disease (PKD) and Alport syndrome. Management of pediatric kidney diseases involves a multidisciplinary approach, including pediatric nephrologists, urologists, dieticians, and social workers. Treatment may include medication therapy, dietary modifications, and in severe cases, dialysis or kidney transplantation. Early detection and management of kidney diseases in children are essential to prevent complications and improve outcomes for affected children.

Nutrition plays a crucial role in the management of kidney diseases, as the kidneys are responsible for filtering waste products and excess fluids from the body. Patients with kidney disease often require dietary modifications, including a reduction in protein, sodium, and potassium intake, to reduce the workload on the kidneys and prevent further damage. Adequate caloric intake is also important to prevent malnutrition, which can occur in advanced stages of kidney disease. In some cases, supplementation with vitamins and minerals may be necessary to manage nutrient deficiencies. Close collaboration between patients and healthcare professionals, including dietitians, is crucial in managing nutrition and optimizing outcomes for patients with kidney disease.

Geriatric nephrology is a specialized field of medicine that deals with the diagnosis and management of kidney diseases in older adults. As people age, the kidneys undergo structural and functional changes, increasing the risk of developing kidney diseases such as chronic kidney disease (CKD) and acute kidney injury (AKI). Management of kidney diseases in older adults requires a tailored approach that takes into account the individual's comorbidities, medication regimen, and overall health status. Treatment may include medication therapy, dialysis, or kidney transplantation, depending on the severity and stage of kidney disease. Close collaboration between healthcare professionals, including geriatricians and nephrologists, is essential to optimize outcomes for older adults with kidney disease.

Patient-centered care is an approach to healthcare that emphasizes the patient's values, preferences, and needs in the decision-making process. In the management of kidney diseases, patient-centered care involves actively involving patients in their care and considering their unique circumstances and preferences when making treatment decisions. This includes providing patient education and involving patients in shared decision-making, such as choosing the most appropriate treatment option. Patient-centered care also involves providing support and resources to help patients manage their condition and improve their quality of life. By prioritizing patient-centered care, healthcare professionals can improve patient outcomes and satisfaction while providing more personalized and effective care.