[Prevention and screening in nephrology]

Chronic kidney disease (CKD) is common but without screening is often first detected at a very late stage. For the patients CKD is very burdensome and costly. In early stages, CKD causes no or very few symptoms and it is therefore often overlooked for a long time. CKD can be detected cost-effectively using two simple laboratory parameters, the estimated glomerular filtration rate (eGFR) for assessment of kidney function and the urine albumin-creatinine ratio (UACR) for assessment of kidney structure but for budgetary reasons these two investigations are often not performed. For these reasons, these two tests should be regularly included in screening procedures, without burdening the laboratory budget. The general healthcare check-up covered by the statutory health insurance system (GKV) only includes testing for  urinary proteins using urine test strips, which are however prone to error and not sufficiently sensitive and therefore suboptimal for an early detection. Patients at risk should be tested annually. Using early and adequately sensitive diagnostics (eGFR and UACR) appropriate treatment, such as with sodium-glucose transporter type 2 (SGLT2) inhibitors, can markedly slow the progression to high-grade CKD and therefore possibly avoid kidney replacement procedures.