Early Detection, Better Prognosis- How to Approach Kidney Disease Diagnosis

Dr. Shivani Sharma, an expert in Pulmonary pathology. She has a total of 10 years of experience in Onco- Pathology, out of which, 7 years of experience are also in Molecular Pathology including FISH. She has also presented her work at various national and international conferences (IASCLC, USCAP). She is also leading the quality department and has experience in CAP and NABL accreditation audits.

In conversation with Charulatha, Correspondent, Silicon- india Magazine. Shivani Sharma emphasizes the vital collaboration between nephrologists and primary care physicians. Integrating electronic health records enhances kidney disease diagnosis efficiency and accuracy.

Techniques such as Doppler ultrasound assess blood flow to the kidneys, helping diagnose conditions like renal artery stenosis and ischemia

1. Can you provide an overview of the current methods and technologies used in the early detection of kidney diseases?

Overview of some common methods for early detection:
(1) Blood Tests:

Serum Creatinine: Elevated levels may indicate impaired kidney function.
Blood Urea Nitrogen (BUN): Measures the amount of nitrogen in the blood that comes from urea. Elevated levels can suggest kidney problems.

(2) Urine Analysis:

Proteinuria: Presence of excess protein in the urine may indicate kidney damage.
Hematuria: Presence of blood in the urine may be a sign of kidney disease.
Microalbuminuria: Detects small amounts of albumin in the urine, which can be an early sign of kidney damage, especially in diabetes.

(3) Imaging Studies:

Ultrasound: Provides images of the kidneys, helping to identify structural abnormalities or obstructions.
CT Scan or MRI: These imaging techniques can provide more detailed images, helping to diagnose kidney diseases and identify complications.

(4) Biopsy:

Kidney Biopsy: It is typically done when other tests do not provide a clear diagnosis and includes light microscopy and electronmicroscopy.

Techniques such as Doppler ultrasound assess blood flow to the kidneys, helping diagnose conditions like renal artery stenosis and ischemia

5) Genetic Testing:

• Genetic screening for inherited kidney diseases: Especially relevant for individuals with a family history of kidney diseases.

2. How do medical imaging advances aid early kidney disease detection, and what challenges require addressing for improved diagnosis?

(1) Early Identification of Structural Abnormalities:

• Imaging modalities like ultrasound, CT scans, and MRI allow for the visualisation of the kidneys, helping identify structural abnormalities, cysts, tumors, or obstructions.

(2) Assessment of Kidney Size and Shape:

• Enlarged or atrophied kidneys can be indicative of certain kidney diseases. Imaging enables the assessment of kidney size, shape, and symmetry.

(3) Evaluation of Blood Flow:

• Techniques such as Doppler ultrasound assess blood flow to the kidneys, helping diagnose conditions like renal artery stenosis and ischemia.

(4) Functional Imaging:

•Nuclear medicine imaging, such as renal scintigraphy, provides information about kidney function by tracking the distribution of a radioactive tracer.

(5) Guidance for Biopsy or Interventional Procedures:

•Imaging modalities like ultrasound or CT scans are used to guide needle biopsies or other interventional procedures, ensuring precise targeting of abnormal areas.

3. Can you discuss the importance of collaboration between nephrologists, primary care physicians, and other healthcare professionals in achieving early detection and better prognosis for kidney diseases?

Primary care physicians are often the first point of contact for patients. They play a key role in identifying risk factors, conducting routine screenings, and recognizing early signs of kidney dysfunction. Collaboration with nephrologists enables timely referral of patients with suspected or confirmed kidney diseases for further evaluation and specialized care.

4. How can the integration of electronic health records (EHRs) contribute to more efficient and accurate diagnosis of kidney diseases?

The integration of electronic health records (EHRs) can significantly contribute to more efficient and accurate diagnosis of kidney diseases by providing healthcare professionals with comprehensive, real-time, and easily accessible patient information.

"The future of personalized medicine in kidney disease holds promise for tailored treatments based on genetic, molecular, and lifestyle factors"

5. From a global perspective, what are the disparities in early detection and prognosis of kidney diseases, and what steps can be taken to address these disparities?

The prevalence of kidney disease and the delivery of its care are shaped by socioeconomic, cultural, and political influences, resulting in notable disparities in disease burden, even within developed nations.

(1) Considerable international variation exists in the distribution of the kidney care workforce, particularly nephrologists.

Steps to Address:

Medical Education Programs: Implement training programs for healthcare professionals, focusing on kidney disease awareness, early detection, and management.

Global Health Collaborations: Foster collaborations between institutions and professionals in regions with varying levels of expertise to share knowledge and resources.

(2) Limited availability of diagnostic resources, including laboratory facilities and imaging equipment, can hinder early detection.

The distribution of renal replacement therapy (RRT) technologies exhibited significant variation. While all countries indicated the presence of long-term hemodialysis services, and over 90% of countries reported the availability of short-term hemodialysis services, there was substantial inequity in access and distribution across different countries and regions. Notably, obtaining RRT services often involved substantial out-of-pocket expenses, especially in low-income region.

Steps to Address:

Investment in Healthcare Infrastructure: Governments and international organizations should invest in healthcare infrastructure, ensuring that facilities are equipped with the necessary diagnostic tools for early detection.

Telemedicine: Utilize telemedicine and mobile health technologies to reach remote or underserved areas, providing virtual consultations and diagnostic support.

(3) Socioeconomic factors, such as poverty, affect access to healthcare, nutrition, and the ability to manage chronic conditions.

Steps to Address:

Income Support Programs: Implement social programs and policies that provide financial support to individuals with low income, ensuring they can afford necessary healthcare services and medications.

Community Support Services: Develop community-based support services to address social determinants of health, such as housing, nutrition, and employment, which impact kidney health.

6. How do you envision the future of personalized medicine in the context of kidney disease diagnosis and treatment?

The future of personalized medicine in kidney disease holds promise for tailored treatments based on genetic, molecular, and lifestyle factors. Advances in genomics, biomarkers, and digital technologies will enable precise diagnostics and individualized therapies. This approach aims to optimize outcomes, minimize complications, and revolutionize the management of kidney diseases on a patient-specific level.

(The inputs are shared by Dr. Shivani Sharma, Vice President of Pathology Services & Lab Director, CORE Diagnostics)