Clinical Protocols for Major Chronic Diseases in Kazakhstan
1. Arterial Hypertension (AH): Diagnosis and Management
Topics Covered: Epidemiology of arterial hypertension (AH), classification, risk stratification (SCORE scale assessment of cardiovascular risk), laboratory and instrumental diagnostics of AH, diagnostic criteria, differential diagnosis of elevated blood pressure, and management strategy based on the degree of hypertension, risk groups, and comorbidities.
AH Management Summary:
Arterial Hypertension (AH) is a widespread chronic disease and a major cause of cardiovascular morbidity and mortality. Risk factors include age, heredity, obesity, high salt intake, physical inactivity, smoking, alcohol, diabetes, and dyslipidaemia.
AH Classification and Risk Assessment
- Classification: AH is classified by blood pressure (BP) level into stage 1 (140–159/90–99 mmHg), stage 2 (160–179/100–109 mmHg), and stage 3 (≥180/≥110 mmHg).
- Risk Assessment: Cardiovascular risk is assessed using the SCORE scale, which estimates 10-year fatal cardiovascular risk.
Diagnosis and Treatment Goals
Diagnosis is based on repeated BP measurements, Ambulatory Blood Pressure Monitoring (ABPM) or home BP monitoring, laboratory tests, and instrumental studies (ECG, echocardiography). Management depends on BP level, total risk, and comorbidities, combining lifestyle changes with antihypertensive drugs. Target BP is usually <130/80 mmHg, with LDL-C targets adjusted according to risk. Regular follow-up is required. National MoH RK protocols are aligned with ESC guidelines and emphasize individualized, risk-based treatment.
2. Community-Acquired Pneumonia (CAP) Protocols
Topics Covered: Etiological factors of community-acquired pneumonia, clinical classification of CAP, diagnostic criteria, indications for hospitalization, laboratory and instrumental examinations for CAP, and indications for referral to specialists.
CAP Management Summary:
Community-Acquired Pneumonia (CAP) is an acute lung infection acquired outside the hospital, most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria, and respiratory viruses. Clinically, it is classified as mild, moderate, or severe.
Diagnosis and Hospitalization Criteria
Diagnosis is based on fever, cough, dyspnea, lung findings, and chest X-ray infiltrates. Hospitalization is needed for severe cases, respiratory failure, elderly patients, or those with comorbidities.
Diagnostic Evaluation
Laboratory and instrumental evaluation includes:
- Complete Blood Count (CBC), C-Reactive Protein (CRP), procalcitonin.
- Sputum and blood cultures.
- Chest X-ray and pulse oximetry.
Specialist referral is required for severe disease, complications, or treatment failure. Treatment follows clinical protocols with empiric antibiotics and supportive care. Prevention focuses on vaccination, early treatment, and comorbidity management, while follow-up involves monitoring symptoms, vitals, labs, and repeat imaging if necessary.
3. Chronic Obstructive Pulmonary Disease (COPD)
Topics Covered: Epidemiology and risk factors for COPD, pathogenetic mechanisms and morphological changes in COPD, clinical manifestations, and diagnostic criteria.
COPD Management Summary:
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease mainly caused by smoking and air pollution. It involves chronic airway inflammation and emphysema, leading to irreversible airflow limitation. Symptoms include chronic cough, sputum production, and dyspnea.
Diagnosis and Treatment
Diagnosis is confirmed by spirometry (FEV₁/FVC < 0.7). Differential diagnosis includes asthma and heart failure. Disability depends on disease severity and respiratory failure. MoH RK protocols follow GOLD guidelines, focusing on smoking cessation, bronchodilators, and prevention of exacerbations.
4. Chronic Kidney Disease (CKD) Management and Follow-up
Topics Covered: Definition and classification of CKD, diagnostics, differential diagnosis, outpatient treatment approaches, prevention, dynamic follow-up at the Primary Health Care (PHC) level, and the Clinical protocol of the MoH RK.
CKD Management Summary::
Chronic Kidney Disease (CKD) is a progressive loss of kidney function lasting ≥3 months, classified by Glomerular Filtration Rate (GFR) stages (G1–G5) and albuminuria. Diagnosis is based on GFR, serum creatinine, and urine tests.
Treatment and Prevention
Differential diagnosis includes acute kidney injury and reversible kidney disorders. Outpatient treatment focuses on:
- Blood pressure and glucose control.
- Lifestyle changes.
- Renoprotective medications.
Prevention includes managing risk factors (hypertension, diabetes) and avoiding nephrotoxins. Follow-up at primary care involves regular lab monitoring, risk assessment, and patient education. MoH RK protocols align with international CKD guidelines.
5. Joint Syndrome: Rheumatoid and Reactive Arthritis
Topics Covered: Classification of rheumatoid arthritis (RA) and reactive arthritis, and management and treatment of RA and reactive arthritis according to diagnostic and treatment protocols of the Republic of Kazakhstan at the PHC level.
Joint Syndrome Summary:
Joint syndrome includes inflammatory joint diseases such as rheumatoid arthritis (RA) and reactive arthritis. RA is a chronic autoimmune disease causing symmetrical polyarthritis, while reactive arthritis is an acute, post-infectious asymmetric arthritis.
Diagnosis and PHC Management
Diagnosis is based on clinical signs, lab tests (ESR, CRP, RF, anti-CCP), and imaging. Management at the PHC level in Kazakhstan includes:
- NSAIDs (Nonsteroidal Anti-inflammatory Drugs).
- DMARDs (Disease-Modifying Antirheumatic Drugs) for RA.
- Short-term antibiotics if indicated for reactive arthritis.
- Physical therapy, following MoH RK protocols.
6. Diabetes Mellitus (DM) Management and Follow-up
Topics Covered: Etiology of diabetes mellitus, clinical classification, indications for planned and emergency hospitalization, main and additional diagnostic measures at the outpatient level, diagnostic criteria for diabetes mellitus, instrumental studies and indications for specialist consultations, differential diagnosis of diabetes, management and treatment of type 2 diabetes, and dynamic follow-up of type 2 diabetes mellitus.
Note on Source Material: The following text was provided in the source document under the Diabetes Mellitus section, but it describes Joint Syndrome. It is included here as per instructions not to remove content.
Joint syndrome includes inflammatory joint diseases like rheumatoid arthritis (RA), a chronic autoimmune symmetrical polyarthritis, and reactive arthritis, an acute post-infectious asymmetric arthritis. Diagnosis uses clinical evaluation, lab tests (ESR, CRP, RF, anti-CCP), and imaging. PHC management in Kazakhstan follows MoH RK protocols with NSAIDs, DMARDs for RA, short-term antibiotics for reactive arthritis if needed, and physical therapy.
7. Chronic Heart Failure (CHF) Diagnostics and Treatment
Topics Covered: Definition of CHF, NYHA classification, classification according to ejection fraction (HFrEF, HFmrEF, HFpEF), etiology (ischemic, hypertensive, valvular, inflammatory, toxic, etc.), major symptoms, signs of right- and left-sided CHF, clinical stages and manifestations of decompensation, and instrumental diagnostics (ECG, echocardiography, chest X-ray, stress tests).
CHF Management Summary:
Chronic Heart Failure (CHF) is a syndrome of impaired heart function leading to fluid retention and reduced perfusion. It is classified by NYHA class I–IV and ejection fraction: HFrEF (reduced), HFmrEF (mid-range), HFpEF (preserved).
Etiology and Symptoms
Causes include ischemic heart disease, hypertension, valvular, inflammatory, or toxic factors. Symptoms include dyspnea, fatigue, and edema; left-sided CHF causes pulmonary congestion, while right-sided CHF causes peripheral edema.
Diagnosis and Treatment
Diagnosis uses ECG, echocardiography, chest X-ray, and BNP/NT-proBNP. Treatment follows MoH RK protocols:
- ACE inhibitors/ARBs.
- Beta-blockers.
- Diuretics.
- Mineralocorticoid antagonists.
Follow-up occurs at PHC, including patient education and secondary prevention. Patients are routed PHC → hospital → cardiology centers, with medications covered under OSMS. Poor prognosis is linked to advanced disease and comorbidities.
8. Bronchial Asthma (BA): GINA Protocol and Prevention
Topics Covered: Definition and classification of BA, etiological factors, risk factors, clinical presentation, diagnostic algorithm, standard treatment of BA (Stepwise therapy, GINA RK protocol), non-pharmacological management, complications, and prevention (primary, secondary, and exacerbation prevention).
BA Management Summary:
Bronchial Asthma (BA) is a chronic inflammatory airway disease with variable airflow obstruction. Causes include allergens, infections, pollution, and genetics; risk factors are atopy, family history, smoking, and occupational exposure. It is classified as intermittent, mild, moderate, or severe.
Diagnosis and Stepwise Therapy
Symptoms include wheezing, cough, dyspnea, and chest tightness. Diagnosis involves history, spirometry, peak flow measurement, and allergy tests. Treatment follows the GINA RK stepwise protocol with inhaled corticosteroids and bronchodilators, plus non-drug measures like allergen avoidance and education. Prevention includes reducing risk factors, monitoring high-risk patients, and preventing exacerbations. PHC physicians manage care, follow-up, and specialist referral, monitoring symptom control and lung function.
9. Peptic Ulcer Disease (PUD) Etiology and Treatment
Topics Covered: Definition of gastric ulcer (GU) and duodenal ulcer (DU), etiology (H. pylori, NSAIDs, stress factors), classification by localization, classification by phases (exacerbation, incomplete remission, clinical remission), and classification by severity and complications.
PUD Management Summary:
Peptic Ulcer Disease (PUD) affects the stomach (gastric ulcer, GU) and duodenum (duodenal ulcer, DU), mainly caused by H. pylori infection, NSAIDs, and stress. It is classified by location, disease phase (exacerbation, incomplete remission, remission), severity/complications, and per MoH RK protocols.
Risk Factors and Treatment
Risk factors include smoking, alcohol, NSAID use, and diet. Symptoms are epigastric pain, nausea, bloating, and sometimes bleeding. Diagnosis involves endoscopy with H. pylori testing, labs, and imaging. Treatment follows MoH RK protocols:
- H. pylori eradication therapy.
- Acid suppression (PPIs).
- NSAID avoidance and lifestyle modification.
Prevention includes primary measures (H. pylori control, NSAID precautions) and secondary measures (relapse prevention, post-eradication monitoring). Follow-up includes symptom monitoring, H. pylori control, and evaluation of treatment effectiveness.
10. Chronic Pancreatitis (CP) Risk Factors and Management
Topics Covered: Definition and classification of Chronic Pancreatitis (CP), classification according to MoH RK clinical protocols, risk factors, and clinical picture.
CP Management Summary:
Chronic Pancreatitis (CP) is a progressive inflammatory disease of the pancreas leading to irreversible damage and impaired exocrine and endocrine function. It is classified by etiology, severity, and MoH RK protocols.
Risk Factors and Clinical Picture
Major risk factors include: alcohol, smoking, gallstones, metabolic disorders, and genetic predisposition. Symptoms include chronic abdominal pain, steatorrhea, weight loss, and diabetes. Diagnosis relies on clinical evaluation, labs (amylase, lipase, glucose), and imaging (ultrasound, CT, MRI, ERCP).
Treatment and Follow-up
Treatment per MoH RK protocols includes:
- Pain management.
- Enzyme replacement.
- Lifestyle modification (alcohol cessation, diet).
- Diabetes management.
Complications include pseudocysts, pancreatic insufficiency, diabetes, and malignancy. Prevention focuses on avoiding risk factors. Care is organized at PHC and specialized centers, with follow-up to monitor symptoms, nutrition, and treatment effectiveness.