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HWANG, SHANG‐JYH; TSAI, JER‐CHIA; CHEN, HUNG‐CHUN
doi: 10.1111/j.1440-1797.2010.01304.xpmid: 20586940
ABSTRACT Chronic kidney disease (CKD) has emerged as a global public health burden. Taiwan has the highest incidence and prevalence rates of end‐stage renal disease (ESRD) in the world. In this review, the following key issues of CKD in Taiwan are addressed: epidemiological data, underlying diseases patterns, risk factors, public health concerns and a preventive project. Prevalence of CKD are reported to be 6.9% for CKD stage 3–5, 9.83% for clinically recognized CKD and 11.9% for CKD stage 1–5. However, overall awareness of CKD is low, 9.7% for CKD stage 1–3 and 3.5% for stage 1–5. Diabetes mellitus (43.2%), chronic glomerulonephritis (25.1%), hypertension (8.3%) and chronic interstitial nephritis (2.8%) are four major underlying renal diseases of ESRD. Older age, diabetes, hypertension, smoking, obesity, regular use of herbal medicine, family members (both relatives and spouses), chronic lead exposure and hepatitis C are associated with higher risk for CKD. Impact of CKD increases risk of all‐cause mortality and cardiovascular diseases, especially in those with overt proteinuria and advanced CKD stages. These impacts lead to increased medical costs. The nationwide CKD Preventive Project with multidisciplinary care program has proved its effectiveness in decreasing dialysis incidence, mortality and medical costs. It is crucially significant from Taiwan experience on CKD survey and preliminary outcome of the preventive project. Provision of a more comprehensive public health strategy and better care plan for CKD should be achieved by future international collaborative efforts and research.
doi: 10.1111/j.1440-1797.2010.01305.xpmid: 20586941
ABSTRACT Alternative and indigenous systems of medicine are popular amongst the poorer sections of society in the developing world. Their use in the developed world has also increased in recent times. The source and composition of these medicines vary in different parts of the world, but herbs and other botanicals are central to these systems. Largely outside the ambit of regulatory control, herbal remedies are prepared by quasi‐trained herbalists and not tested for safety. Toxicity can occur when a herb with unknown toxicity is consumed, incorrect identification leads to substitution of an innocuous herb with a toxic one, preparations are contaminated with toxic non‐herbal compounds or when a herb potentiates the nephrotoxic effect of a conventional therapy. Renal injury has been reported in association with several herbs. The best‐known herb‐induced chronic kidney disease (CKD) is aristolochic acid nephropathy. The condition is characterized by progressive interstitial nephritis, with a proportion of patients developing urothelial malignancies. The toxic compound is aristolochic acid (AA); AA‐DNA adducts have been identified in the renal and urothelial tissues. Recent evidence suggests that AA also contributes to the development of Balkan endemic nephropathy. The role of herbs has been postulated in the development of CKD in other parts of the developing world, especially amongst the rural population. Public awareness and regulation of use of herbal medicines are required to eradicate this entity from the community.
doi: 10.1111/j.1440-1797.2010.01306.xpmid: 20586942
ABSTRACT Low birthweight reflects the congenital defects of organs, which is associated with chronic kidney disease through its direct influence on nephron number and function, also through related metabolic disease‐induced kidney damage. We reviewed the current evidence regarding the role of low birthweight in the pathogenesis of chronic kidney disease.
doi: 10.1111/j.1440-1797.2010.01307.xpmid: 20586943
ABSTRACT Immunoglobulin (Ig)A nephropathy is one of the major causes of chronic kidney disease (CKD) in Japan. Despite statutory urinalysis of industrial workers and school children, Japan unfortunately still ranks among the countries with the highest CKD‐5D prevalence in the world. Topics of this review are as follow: (i) early diagnosis and treatment; (ii) influence of the period from onset to medical intervention on renal prognosis; and (iii) epidemiology of IgA nephropathy patients in Japan. Some investigators have discussed the possibility of predicting the diagnosis and prognosis of this disease. We indicated that the frequency of various casts in urinary sediments and total numbers of each type of urinary cast should provide highly convincing data for prediction of the prognosis in IgA nephropathy patients prior to renal biopsy. Furthermore, early medical intervention (anti‐platelet agents, anticoagulants, angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, corticosteroids and/or tonsillectomy) may lead to better renal prognosis in patients with IgA nephropathy. In a nationwide survey on IgA nephropathy in Japan, predictive factors after 10 years were as follows: (i) male sex; (ii) under 30 years old; (iii) diastolic hypertension; (iv) heavy proteinuria; (v) mild haematuria; (vi) low serum albumin; and (vii) elevated serum creatinine and impaired renal pathology. It appears that substantial renal deterioration can be validly estimated using these predictive factors in patients with IgA nephropathy. In conclusion, early diagnosis, treatment and improvement of predictive factors for a long duration may lead to better renal prognosis in patients with IgA nephropathy.
doi: 10.1111/j.1440-1797.2010.01308.xpmid: 20586944
ABSTRACT The prevalence of treated patients with end‐stage renal disease (ESRD) has been increasing steadily in Japan. High ESRD prevalence could be explained by multiple factors such as better survival on dialysis therapy, luxury acceptance due to insurance system to cover dialysis therapy, and ‘truly’ high incidence and prevalence of chronic kidney disease (CKD). The growing elderly population may also contribute to this trend. The Japanese Society of Nephrology estimated the prevalence of CKD stage 3 as 10.4%, 7.6% within the range of 50–59 mL/min per 1.73 m2 in a screened population. Strong predictors of treated ESRD shown by using community‐based screening programs and an ESRD registry in Okinawa are dip‐stick‐positive proteinuria and hypertension. Low glomerular filtration rate per se, which is often observed in the elderly population, is not a significant predictor of developing ESRD unless associated with proteinuria. CKD is common in Japan and is expected to increase, particularly in the elderly population. Benefits of proteinuria screening and automatic reporting of estimated glomerular filtration rate on the incidence of ESRD remain to be determined.
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