Global Nephrology: Kidney disease in Portugal

I am in Portugal for a few days teaching. Here is a fact: Portugal has the highest prevalence of end-stage renal disease in Europe yet diabetes is the presumed cause in only 11% of patients. The Prevadiab study suggests that the reason for this is a faster rate of progression of CKD in Portuguese patients. An alternative explanation the remarkably high rate of the metabolic syndrome in this population - obesity (33.7%) and metabolic syndrome (41.5%)  greater than in most European countries. Therefore, it is of little surprise that the country has started a CKD screening program modeled on the NKF KEEP program. The Portuguese program is named SCORED and some preliminary data was recently published.

So here is an idea: it would be worth doing a study to see what type of kidney disease these patients actually have. We published a study in 2009 that characterized kidney disease among those with the metabolic syndrome. Here are the key findings: "patients with metabolic syndrome compared with controls had a greater prevalence of tubular atrophy (P = 0.006), interstitial fibrosis (P = 0.001), and arterial sclerosis (P = 0.001), suggesting microvascular disease. Patients with metabolic syndrome had greater global (P = 0.04) and segmental glomerulosclerosis (P = 0.05)."

It would also be interesting to survey patients for environmental risk factors. Our studies in Andhra Pradesh, India that recently got publicized and were the subject of an interview in the NY Times suggest a powerful effect of environmental contamination with heavy metals as the cause for the high rates of CKD in Vishakapatnam.