Diagnostic approach to chronic kidney disease

Chronic kidney disease (CKD) can be considered to be present if a patient has a glomerular filtration rate <60 mL/min or markers of kidney disease that have been present for >3 months. These include proteinuria, haematuria and radiological abnormalities. Regardless of the stage of CKD, the approach is mainly similar. As stated in the South African Renal Society Guidelines for the early detection and management of CKD, early and appropriate investigation and timeous referral of these patients enable one to establish a specific diagnosis; treat reversible diseases; optimise management to slow the progression of CKD; identify and optimally manage comorbid conditions; and plan renal replacement therapy well before the patient develops end-stage kidney disease

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism.

Organ commercialism, which targets vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor countries, has been condemned by international bodies such as the World Health Organization for decades. Yet in recent years, as a consequence of the increasing ease of Internet communication and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have grown into global problems. For example, as of 2006, foreigners received two-thirds of the 2000 kidney transplants performed annually in Pakistan. The Istanbul Declaration proclaims that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad. Moreover, transplant tourists risk physical harm by unregulated and illegal transplantation. Participants in the Istanbul Summit concluded that transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited. And they also urged their fellow transplant professionals, individually and through their organizations, to put an end to these unethical activities and foster safe, accountable practices that meet the needs of transplant recipients while protecting donors. Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop national self-sufficiency in organ donation. The Declaration should reinforce the resolve of governments and international organizations to develop laws and guidelines to bring an end to wrongful practices. "The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require-nor justify-victimizing the world's poor as the source of organs for the rich" (Steering Committee of the Istanbul Summit)