Chronic kidney disease (CKD) is a serious illness with important consequences for patients and health systems. Estimation of prevalence and incidence, especially in early stages, is difficult due to a lack of epidemiological studies and consolidated registries. In general, the disease awareness is low, and thus CKD is not timely diagnosed in most cases. Robust screening programs are not implemented in Eastern European countries. A panel consisting of Primary Care Physicians and Nephrologists from Bulgaria, Croatia, Serbia, and Slovenia virtually met in December 2021 to discuss current CKD awareness and diagnostic approaches in the Balkan area The meeting resulted in specific calls to action in the region to improve the number and quality of epidemiology studies and the level of awareness among patients and medical communities, as well as implementation of screening programs in high-risk populations. Collaboration between specialists was acknowledged as a crucial driver for optimal management of patients with CKD. Joint efforts are required to persuade healthcare authorities to establish specific policies for better care of kidney patients.

The treatment of chronic kidney disease (CKD) has been considerably transformed in the last couple of years. However, effective management of patients with CKD is still not achieved, despite clear guidelines promoting active screening of high-risk patients, immediate diagnosis based on laboratory markers, and early initiation or intensification of pharmacotherapy like sodium/glucose cotransporter 2 (SGLT2) inhibitors, which showed reliable results in preventing disease progression, complications, and mortality. Following a recent initiative on early diagnosis, nephrology experts from Bulgaria, Croatia, Serbia, and Slovenia discussed the challenges and opportunities related to CKD treatment in the Balkan countries, also reflecting on the heterogenous socio-economic context of the region. The ongoing education of all stakeholders involved in kidney care, structured support for primary care providers, and the improvement of multidisciplinary networks were consistently recognized as key success factors. Optimal CKD management is based on continuity of care and the timely transition of coordination from primary care to nephrology-specialized services.

Introduction: The nutcracker syndrome is a rare clinical entity caused by compression of the left renal vein by the superior mesenteric artery. Epidemiologically opposite, IgA nephropathy is the most common cause of idiopathic glomerulonephritis. A combination of the two diseases has previously been reported in a few cases. Case Report: Herein we report a case of a 22-year-old male patient admitted because of macroscopic hematuria due to excessive oral anticoagulation. He had prior evidence of proteinuria, microhematuria, impaired kidney function, and enlarged left kidney. He presented with fatigue, abdominal pain, nausea, and several instances of vomiting after a meal. A diagnosis of left renal vein compression and IgA nephropathy was made based on clinical, laboratory, radiological findings and kidney biopsy. The vascular anomaly was treated conservatively, while steroids were given to treat glomerulonephritis. The result was complete regression of symptoms, normal laboratory findings, and a significant drop in proteinuria. Conclusion: It is important to evaluate whether patients have nutcracker phenomenon before initiating treatment for IgA nephropathy and vice versa, as hematuria and proteinuria can be overlapping symptoms of both conditions. Renal biopsy should not be hesitated for differential diagnosis, and treatment should be highly individualized.