World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc
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Volume 9, Number 1, March 2020, pages 1-10

Kidney Health for Everyone Everywhere: From Prevention to Detection and Equitable Access to Care


Figure 1.
Figure 1. Overview of the preventive measures in chronic kidney disease (CKD) to highlight the similarities and distinctions pertaining to primary, secondary, and tertiary preventive measures and their intended goals.


Table 1. Risk Factors for De Novo CKD and Pre-Existing CKD Progression
Risk factorsaContribution to de novo CKDContribution to CKD progression
aMany of these risk factors contribute to both de novo CKD and its faster progression and hence are relevant to both primary and secondary prevention. ACEI: angiotensin converting enzyme inhibitor; AIN: acute interstitial nephritis; AKI: acute kidney injury; APOL1: apolipoprotein 1; ATN: acute tubular necrosis: BPH: benign prostate hypertrophy; CKD: chronic kidney disease; CNI: calcineurin inhibitor; GN: glomerulonephritis; NASH: non-alcoholic steatohepatitis; NSAID: non-steroidal anti-inflammatory drug; PPI: proton pump inhibitor.
Diabetes mellitusAbout 50% of all CKDs
HypertensionAbout 25% of all CKDs
AgeSeen with advancing age, especially in the setting of comorbid conditions.Some suggests that older CKD patients may have slower progression.
Race, genetics and other hereditary factorsCommon among those with African American ancestors.
  APOL1 gene
  Hereditary nephritis (Alport’s)
Acute glomerulonephritis< 10%Recurrent GN or exacerbation of proteinuria
  Post-infectious GN
  Rapidly progressive GN
Polycystic kidney disorders< 10%, family history of cystic kidney disorders
Acute kidney injury (AKI)Repeated AKI bouts can cause CKDRepeated AKI bouts can accelerate CKD progression.
  Acute tubular necrosis (ATN)
  Acute interstitial nephritis (AIN)
Autoimmune disorders
  Lupus erythematosus
  Other connective tissue disorders
PharmacologicVariable, e.g. in Taiwan, Chinese, herb nephropathy may be an important contributor.
  Medications causing interstitial nephritides (NSAIDS, CNI, chemotherapy, PPI, etc) or ATN (aminoglycosides)
  Herbs and herbal medication
  Heavy metal exposure
Acquired or congenital solitary kidney
  Cancer, donor or traumatic nephrectomy
  Congenital solitary kidney, unilateral atrophic kidney
Acquired urinary tract disorders and obstructive nephropathyBPH in men
Gynecological cancers in women
Congenital anomalies of the kidney and urinary tractMostly in children and young adults
Inadequate fluid intakeUnknown risk, but high prevalence is suspected in Central America.Whereas in earlier CKD stages adequate hydration is important to avoid pre-renal AKI bouts, higher fluid intake in more advanced CKD may increase the risk of hyponatremia.
  Mesoamerican nephropathy
High protein intakeUnknown risk, recent data suggest higher CKD risk or faster CKD progression with high protein diet, in particular from animal sources.Higher protein intake can accelerate the rate of CKD progression.
Cardiovascular diseases (cardiorenal)Ischemic nephropathy
Liver disease (hepatorenal)NASH cirrhosis, viral hepatitis