ALBUMINURIA, KIDNEY FUNCTION AND RISK STRATIFICATION IN PRIMARY CARE: CHALLENGES FOR EARLY IDENTIFICATION OF CHRONIC KIDNEY DISEASE IN THE BRAZILIAN HEALTH SYSTEM

Abstract

Chronic Kidney Disease is a major public health condition, particularly because it often progresses silently and is strongly associated with hypertension, diabetes mellitus, cardiovascular disease and ageing. This chapter aimed to discuss early identification of kidney disease in Primary Health Care, emphasizing the combined assessment of estimated glomerular filtration rate and albuminuria, prognostic risk stratification and continuity of care within the Brazilian Unified Health System. This is a narrative, theoretical and update review based on international guidelines, official Brazilian documents and recent studies related to the detection and management of chronic kidney disease in primary care. The literature indicates that isolated use of serum creatinine may fail to identify individuals with kidney damage and still-preserved filtration, whereas underuse of the urine albumin-creatinine ratio compromises recognition of patients at higher risk. Combining estimated glomerular filtration rate and albuminuria improves diagnosis, prognosis, monitoring frequency and the identification of cases requiring shared nephrology care. It is concluded that improving early detection depends less on indiscriminate population screening and more on systematically incorporating kidney assessment into the care of high-risk groups, following up abnormal results, providing continuing professional education, and organizing care pathways capable of translating laboratory findings into timely kidney-protective interventions.