[Early diagnosis of chronic kidney disease. New insights into creatinine and proteinuria].

The progression of chronic kidney disease (CKD) is more than just a simple, creeping loss of kidney function finally resulting in end-stage renal disease (ESRD). First, the growing incidence of CKD implies an exploding socioeconomic burden. Second, clear evidence indicates that CKD is associated with an independent massive increase in the patient's cardiovascular risk. Concerning screening and early diagnosis of CKD serum creatinine alone is an inadequate parameter for the evaluation of renal function. Proteinuria is both an indicator of renal damage as well as a progression factor for ongoing loss of renal function. Optimized treatment of arterial hypertension is of outstanding importance in the management of CKD patients, since high blood pressure is directly as well indirectly, via proteinuria, related to progression of CKD. Agents interfering with the renin-angiotensin system have been proven to be especially effective in antiproteinuric treatment and in slowing the progression of CKD. Our current understanding of optimized antihypertensive and antiproteinuric therapy favors a multimodal treatment regimen. Reduction of proteinuria toward levels < 0.5 g per day would be ideal. By this intervention the risk for both ongoing renal function loss as well as the risk of cardiovascular disease can be markedly reduced.