糖尿病CK指南.pptVIP

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations forDiabetes and Chronic Kidney Disease Am J Kidney Dis 49:S1-S180, 2007 (suppl 2) 主要内容： 主要内容： II. CLINICAL PRACTICE GUIDELINES Background: great burden of diabetes and CKD GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETICKIDNEY DISEASE 1.1 Patients with diabetes should be screened annually for DKD (Diabetic kidney disease). Initial screening should commence: ● 5 years after the diagnosis of type 1diabetes; (A) or ● From diagnosis of type 2 diabetes. (B) 1.1.1 Screening should include: ● Measurements of urinary ACR (Albumin-creatinine ratio) in a spot urine sample (B) ● Measurement of serum creatinine and estimation of GFR (B) GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETICKIDNEY DISEASE 1.2 An elevated ACR should be confirmed in the absence of urinary tract infection with 2 additional first-void specimens collected during the next 3 to 6 months. (B) ● Microalbuminuria is defined as an ACR between 30-300 mg/g ● Macroalbuminuria is defined as an ACR 300 mg/g ● 2 of 3 samples should fall within the microalbuminuric or macroalbuminuric range to confirm classification GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETICKIDNEY DISEASE 1.3 In most patients with diabetes, CKD should be attributable to diabetes if: ● Macroalbuminuria is present; (B) or ● Microalbuminuria is present in the presence of diabetic retinopathy, (B) in type 1 diabetes of at least 10 years’ duration. (A) Definitions of Abnormalities in Albumin Excretion GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETICKIDNEY DISEASE 1.4 Other cause(s) of CKD should be considered in the presence of any of the following circumstances: (B) ● Absence of diabetic retinopathy; ● Low or rapidly decreasing GFR; ● Rapidly increasing proteinuria or nephrotic syndrome; ● Refractory hypertension; ● Presence of active urinary sediment; ● Signs or symptoms of other systemic disease; ● 30% reduction in GFR within 2-3 months after initiation of an