Blog entry by Meguid El Nahas

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by Meguid El Nahas - Monday, 13 June 2016, 11:09 AM
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Are modern days nephrologists becoming Don Quixotes fighting delusionary fights...?!

Don Quixote in the novel of Cervantes looses his mind after so much reading....and goes on a self assigned mission to fight illusionary enemies...including windmills....

Have modern days nephrologists, also lost their sense falling prey to the brainwashing unslaught of publications on CKD definition, classification, detection and prevalence...leading them to beleive that CKD, the ultimate foe is everywhere...beleiving that up to 1 in 2 of living humans will fall to that disease...and its growing "epidemic"... are they also off to fight a delusionary battle "against CKD"...

When will nephrologists stop referring to CKD (Chronic Kidney Disease) as a "disease" ?

when in reality we use functional criteria that imply a reduction in function rather than a "disease" entity...in fact, there isnt an epidemic of "CKD"... there is just a deliberate misrepresentation of what is generically termed CKD...

And, how can we label all those with a reduced kidney function as suffering from the same "Disease" when in reality they suffer from a number of underlying causes or diseases...ranging from glomerulonephritis, diabetes, hypertension, vasculitis, interstitial nephritis or hereditart kidney diseases including cystic malformations... not to mention a majority labelled as "diseased' when in reality all they suffer from is the "disease" of old age...and the associated reduction in the function of most organs including the kidneys...

Worse still, how can we have a classification that pretends a staging and continuity from CKD1 to 5...when those suffering from CKD 1 to 3a...mostly older people, seldom progress to CKD 4 or 5...whilst those who end up in CKD4 and5 often present acutely with severe renal dysfunction as in glomerulobnephritis, vasculitis, and acute kidney injury... and never go through stages 1 and 2...

Consequently, research shows that early detection to prevent CKD progression is a myth and an illusion...you would need to detect and unecessarily treat thousands for years to prevent 1 ESRD...as we are not detection and treating those who progress to ESRD...

http://www.ncbi.nlm.nih.gov/pubmed/24424348

Proteinuria changes the detection-prevention risk v benefit ratio, but then proteinuria identifies those with true disease compared to those who are labelled as "diseased"... those with glomerulonephritis, diabetic nephropathy or advanced hypertensive nephrosclerosis... compared to the community elders labelled with a "disease" they dont have...

Is it therefore time to drop this generic and misleading term "CKD"...or leave it to epidemiologists to collect and compile meaningless information on population they never saw or truly investigated...for the sake of publishing repetitive papers on the prevalence of "CKD" in communities... leave it to the Don Quixotes of Nephrology...

and revert to identify patients by their true renal abnormalities: hematuria, proteinuria, glomerulonephritis, vasculitis, lupus nephritis, diabetic nephropathy, etc...and tailor approach and treatment accordingly.

This would allow for an individualisation of management approach instead of the one size fits all current generic "CKD" prevention, diagnosis and management approach...

http://www.ncbi.nlm.nih.gov/pubmed/22189037

It is often difficult to rail against the wind...even when the wind blows in the wrong direction...but then if we dont, we get also blown off in the wrong direction...and continue for the next decades to chase and treat a "disease" that doesnt exist...Don Quixote's style...fighting delusionary windmills...those of modern day "CKD"...

[ Modified: Thursday, 1 January 1970, 1:00 AM ]