Why is CKD at 20 often diagnosed late?

Question

Hi doctor,

I am writing to you since my younger brother, 20, has just been diagnosed with Stage 3b chronic kidney disease, entirely out of the blue, at a health check-up.

The results of his tests have shown an eGFR of 34 and a creatinine of 2.4. It was a major surprise to our family since we did not know that the functions of his kidneys were impaired that severely. Over the years, he had no visible swellings, pain, or other symptoms. Even his nephrologist began talking about dialysis in the future, which is very hard for our family to digest.

I have some questions that I would appreciate your help in answering.

Is the lack of diagnosis of chronic kidney disease in young people, as young as 20, caused by the absence of symptoms, or are there symptoms that usually go unnoticed?
Should not he have had earlier screenings since he suffered from mild hypertension since the age of 17?
In Stage 3b, what are the measures that can be taken to help prevent the deterioration of CKD as much as possible?
Is there anything in the pipeline of new treatments or medical research aimed at improving chronic kidney disease among younger patients?

Thank you for taking the time to read my questions.

Your guidance will be greatly valued.

Answer 1

Hi,

Welcome to icliniq.com.

It is awful hearing that your brother has been diagnosed with the condition. Getting the news of having chronic kidney disease at such an age, when no symptoms were expected to arise, is very saddening.

What you described above is quite common. In the early and even intermediate phases of chronic kidney disease, the kidneys may lose a considerable percentage of their function without showing any symptoms due to their great compensatory capacity.

Early symptoms such as feeling tired, changes in urinary frequency, or slightly high blood pressure are non-specific and easy to ignore or misinterpret as something else. Hence, many people find out about their problem only when their blood test results indicate a decrease in their kidney function.

The fact that your brother has an eGFR of 34 indicates that he is suffering from stage 3b CKD, which might have occurred after some silent progression within several years. In this context, it must be considered that the past presence of slight hypertension at the age of 17 years in his medical history could indicate that his high blood pressure could have been caused by the development of the disease.

While the disease could have been detected through the application of early screening methods using blood (for instance, serum creatinine) and urine tests (for the presence of protein), it should be noted that kidney screening among healthy young people is not a common practice.

The reason for this is the absence of symptoms in the presence of the disorder. However, since your brother is only 20 years old, the specialist treating him will definitely conduct further examinations to identify the underlying causes of the disease.

However, despite the severity of the condition, one should note that there is an opportunity to stop its progression at this stage. Management includes the following aspects:

Maintenance of proper blood pressure control with the help of drugs like (Angiotensin-converting enzyme inhibitors )ACE inhibitors and (Angiotensin II receptor blockers)ARBs.
Decrease in the level of proteinuria.
Observance of a special renal diet in accordance with the specific recommendations of medical specialists.
Avoidance of nephrotoxic medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs) and others.
Regular visits to a nephrologist for follow-up examinations.

Recently, new medicines like sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors), originally designed for the treatment of diabetes mellitus, are widely used to protect renal function in patients, including those without diabetes mellitus, depending on the patient's particular condition.

Nowadays, there are intensive investigations carried out in the field of chronic kidney disease. They are aimed at the improvement of the effectiveness of existing methods of treatment, the development of a more personalized approach depending on the nature of the disorder, and the study of new drugs in clinical trials. The accurate diagnosis becomes critical in the case of younger patients since there are types of kidney diseases that have specific therapy options.

Even though talking about dialysis may be rather terrifying, nephrologists usually begin these talks much earlier than when dialysis becomes inevitable. It gives both the patient and his relatives sufficient time to get acquainted with the treatment opportunities available, prepare for what might happen in the future, and make the right decisions in case the illness gets worse. However, mentioning dialysis at the current stage does not mean that it will become necessary soon. Many people with stage 3 CKD preserve normal kidney functioning for years thanks to proper treatment.

I hope that these details have shed some light on this issue for you.

I hope everything goes well with your brother and your family.

Thank you.