Chronic kidney disease (CKD) is becoming increasingly common around the world, posing a serious threat to public health and the economy. It is a condition in which the kidneys gradually lose their function and can progress slowly over many years, sometimes without even noticeable symptoms in the early stages. However, CKD can lead to serious complications, including kidney failure and cardiovascular disease, if not detected and controlled in a timely manner.

The problem is in the numbers

Data from the World Health Organisation show that about 840 million people in the world suffer from chronic kidney disease (CKD). In Kazakhstan, one in ten people suffer from the disease, but only one in seven is diagnosed with CKD. Today, about 3,600 Kazakhstan citizens, including more than 80 children, are on the waiting list for a kidney transplant.

Causes and risk factors

Diabetes mellitus, arterial hypertension and obesity are the main causes of CKD. Other factors such as genetics, inflammatory diseases, unhealthy habits and long-term exposure to toxins can also increase the risk of developing CKD.

Diagnosis and treatment

Several key tests are used for laboratory diagnosis of chronic kidney disease (CKD) to determine kidney function, creatinine levels, and other important parameters:

• Creatinine in the blood: Creatinine, a metabolic product formed in muscle tissue, is normally excreted through the kidneys. Elevated blood creatinine levels may indicate impaired kidney function as the kidneys become less able to remove it from the body.
• Assessment of the glomerular filtration rate (GFR): This test assesses how well the kidneys are filtering blood. The CKD-EPI formula is used to calculate the glomerular filtration rate in adults and the Schwartz formula in children. The normal CBF is about 90-120 ml/min/1, 73 m².
• Urine albumin-creatinine ratio: Urine albumin levels may be elevated in the presence of kidney damage, which can be an early sign of CKD. This test is often used to detect proteinuria.
• Measurement of electrolytes (sodium, potassium and others) in the blood: CKD can cause disturbances in the balance of electrolytes in the body, so measuring their levels in the blood is important to assess kidney health.

These tests allow physicians to assess kidney function and detect the presence or progression of CKD. The results of laboratory tests can also be used to select appropriate treatment and monitor the effectiveness of ongoing therapy.

Instrumental diagonstics of CKD:

• Kidney ultrasound (U/S);
• Computed tomography;
• Magnetic resonance imaging (MRI).
• Radiography with injection of contrast agents:

Treatment is aimed at slowing the progression of the disease, controlling symptoms and preventing complications. This may include medication, lifestyle changes and in some cases even dialysis or kidney transplantation.

Challenges and prospects

Although medicine has made considerable achievements in the diagnosis and treatment of CKD, it remains a public health challenge. Improving access to healthcare and educating the public about risk factors and prevention methods can play a key role in reducing the prevalence of this disease.

Conclusion

CKD is a serious public health problem that requires a comprehensive approach by the medical community, society and government agencies. Providing resources for early diagnosis, public education and affordable treatment are key steps to reducing the health impact of CKD.

According to statistics, one in four people suffers from allergies. If you are among these people, do not despair! Allergen-specific immunotherapy (ASIT) will help you forget about allergies.

Tablets and capsules, drops and sprays only mask allergy symptoms. ASIT actually gets rid of the disease! At the moment, this is the only method of treating IgE-mediated allergic diseases that has a long-lasting effect on clinical manifestations and modifies the course of the disease.

The main advantages of ASIT:

• Significantly reduces allergy symptoms until they disappear completely; 
  
• Allows you to stop taking regular allergy medications; 
  
• Helps to avoid subsequent sensitization; 
  
• Prevents rhinitis from turning into asthma. 
  
• ASIT is a way not only to eliminate unpleasant manifestations of the disease, but also to completely defeat allergies. This effect is achieved by exposing the body to allergens in increasing concentrations, starting with small doses. A gradualincrease in the dose allows you to develop resistance to the effects of the allergen.

Such therapy exists for various respiratory (inhaled) allergens:

• Pollen (trees, cereals and weeds) 
  
• Fungal molds mites 
  
• Animal allergens (cats, dogs) 
  
• Mould 
  

Not every country has the full range of allergens, but the professional communities of each country are working on this, and in the near future we will be able to treat all existing allergens.

There are several factors that may hinder the clinical effectiveness of ASIT. First of all, ASIT is prescribed only if the patient has allergy symptoms, which are confirmed by laboratory tests. If the tests are positive, but this does not coincide with the symptoms (or vice versa), then ASIT is not prescribed.

Diagnosis before ASIT and identification of a causally significant allergen is an integral part of preparation for therapy. It is known that the maximum effect of therapy is observed with true sensitization of the patient to the source of the allergen, and with a cross-reacting reaction, the effectiveness of ASIT will decrease.

To determine the true allergy, the determination of the IgE level to major and minor allergens is shown. Each source of allergens contains all these allergens together, therefore, extract allergodiagnostics is insufficient to predict the effectiveness of therapy. Molecular allergodiagnostics are necessary: ImmunoCAP helps to determine the level of IgE to individual allergenic components with maximum sensitivity.

A number of analysis have been registered to predict the effectiveness of ASIT to pollen, epidermal and mold allergens separately by ImmunoCAP and to allergens of fungal molds mites as part of ISAC

Timothy grass rPhl p1, IgG4 (ASIT monitoring)
Timothy grass rPhl p5, IgG4 (ASIT monitoring)
Ambrosia nAmb a1, IgG4 (ASIT monitoring)
Birch rBet v1, IgG4 (ASIT monitoring)
Wormwood nArt v1, IgG4 (ASIT monitoring)
ASIT is made in the period from November to March-April (before the beginning of flowering plants). If you are allergic to fungal molds mites, therapy can be made all year round (if it is not combined with a pollen allergy). The main mechanism of action of ASIT is the induction of antibodies that compete with IgE, thereby preventing the development of an allergen reaction. These blocking competing antibodies usually belong to IgG4. Thus, during the treatment of ASIT, the level of specific IgG4 increases.

So how do you know if ASIT is working or not? Molecular allergodiagnostics will help us answer this question again. But not with the determination of IgE, but with the determination of specific IgG4 by ImmunoCAP. The absence of an increase in the concentration of specific IgG4 to those allergen molecules to which therapy is given indicates either an unresponsiveness of the immune system to the drug or the absence of specific allergen components in the drug used for treatment. Thus, the detection of insufficient induction of a protective immune response during vaccination will help to decide whether to continue ASIT, modify it - for example, using a vaccine from another manufacturer - or discontinue this therapy.

Timothy grass rPhl p1, IgG4 (ASIT monitoring)
Timothy grass rPhl p5, IgG4 (ASIT monitoring)
Ambrosia nAmb a1, IgG4 (ASIT monitoring)
Birch rBet v1, IgG4 (ASIT monitoring)
Wormwood nArt v1, IgG4 (ASIT monitoring)