Editorial: Early Diagnosis of Kidney Disease in Young Adulthood

Antonino Sidoti^1*Vincenzo Panichi²

• ¹Azienda USL Toscana sud est, Arezzo, Italy
• ²Universita degli Studi di Pisa, Pisa, Italy

We consider that 25% of people arriving at dialysis have no diagnosis of the type of kidney disease they are affected by. A debate has arisen to understand whether case-finding in high-risk subjects, such as those with a family history of kidney disease or other risk factors, or screening at a population-wide level, is advisable. The former approach targets individuals who are more likely to have the disease, while the latter aims to identify cases in the entire population. Population-wide screening seems advisable in low-income countries where transplant and hemodialysis are not widely available due to a lack of economic resources and expertise. In high-income countries, population-wide screening would be cost-effective if CKD has a high prevalence (1). The last years have shown a progressively diminishing age cost-effectiveness in participants in wide population screening. CKD and cardiovascular risk have a two-way connection (1). Efforts are made in dialysis to prevent high mortality, 22.83% at 4 years, mainly due to cardiovascular and nutritional risk, in patients aged 18-59, with a suggestion to analyze CKD approaches at the country level (Lei Sun et al.). Data on Alport disease (2,3) and IgA nephropathy (2,4) indicate that these diseases can be detected, even if it is not currently possible at the individual level, in the general population through the coupling of biomarkers and genetic information work-up. Mutations in COL4A3, COL4A4, or COL4A5 have a range of phenotypic impacts that span from Alport syndrome to thin basement membrane nephropathy, passing through focal glomerulosclerosis or no disease at all. Early diagnosis of these mutations and clinical follow-up could help elucidate the mechanisms of disease. An early diagnosis allows a cost-effective, kidney-preserving function treatment as SGLT2 inhibitors (5), ARBs, ACE inhibitors, and, in the future, non-steroidal Aldosterone receptor blockers. In IgA, early detection could aid in the use of new therapies (6); targeting specific kidney diseases could help treat larger populations promptly. Proteinuria is a crucial component of CKD screening. In the quest for accuracy, between 24-hour urine collection and urinary creatinine/albumin ratio, formulas adapted to the population have been developed to replace 24-hour urine collection with a better performance in people less than 65 y.o., urinary protein/creatinine ratio less than 500 mg/g, so amenable to use in young population for screening sake (Yu Jia et al) this is a stimulus to develop formulas specific for a determinated populations refraning to use 24 hours collection in extensive population studies. Measurement of Blood pressure is a mainstay of CKD screening. In children and adolescents, elevated blood pressure levels increase the risk of major kidney adverse events in the long term (8). A comprehensive phenotypic description of the disease (Chun-Yu-Suong et al.) enables us to go beyond the already known effects of the mutation; in this case, a complex kidney and reproductive dysfunction is discovered at age 23, starting from a diagnosis of MODY, emphasizing the urgency and significance of early and timely diagnosis of CKD. Early screening for CKD not only enables a more precise classification of the disease beyond the sole kidney biopsy but also paves the way for personalized care and immunosuppressive therapy. This approach enables a follow-up that empowers the nephrologist to make a significant impact on the patient's care. The goal is to prevent the patient with the kidney disease from falling into dialysis and transplant, slowing down the progression of kidney failure, treating concomitant complications, and, when substitutive therapy is mandatory, allowing the patient to arrive in the best condition for the treatment. The knowledge of disease mechanisms at the cellular level is of foremost importance to slow the progression of kidney failure i.e., stabilize GFR levels over time: Yu-Hsi Chiang et al. have studied low brain-derived neurotrophic factor, a crucial player in energy homeostasis, already known to be associated in non diabetes mellitus (DM) CKD, demonstrating its relevance also in diabetes mellitus-related CKD with low levels connected with high level of vascular adhesion molecule-1 (VCAM-1) a factor involved in in attachment of white blood cells to the inner lining of blood vessels. AI could help us identify, with the aim of CKD screening, which data are more predictive of the future development of CKD. We could achieve this goal in a big database, finding the best mixing of parameters coming from anamnestic data, blood routine, and urinalysis (8)