腎脏疾病的诊治进展与临证经验.pptVIP

肾脏疾病的诊治进展与临证经验 China-Japan Friendship Hospital, Beijing, China Li Ping 肾脏疾病的新分类 急性肾脏损伤（Acute Kidney Injuries, AKI） 慢性肾脏病（Chronic Kidney Disease, CKD） AKI的诊断标准 ◆ 肾功能在48小时内突然降低 至少两次Scr升高绝对值0.3mg/dl（26.5umol/L） Scr较前升高50% ◆ 持续6小时以上尿量0.5ml/kg/h 符合下列条件之一： 单独应用尿量的改变作为诊断标准时，需要除外尿路梗阻或其他可导致尿量减少的原因。 AKIN Organizing Committee 2005 2005年9月阿姆斯特丹AKI的国际研讨会 AKI的RIFLE分级 反映预后 AKI合作研讨会标准 (Acute rise ?0.5 mg/dl) 2005年9月阿姆斯特丹AKI的国际研讨会 反映预后 AKI的改良RIFLE分级 J Himmelfarb. Kidney International (2007) 71, 971–976. AKI的RIFLE分期与预后 2005年bell等回顾性分析207名CRRT治疗的AKI患者 首次采用RIFLE分期评价AKI的预后 Bell. Nephrol Dial Transplant (2005) 20: 354–360 R I F L+E 尿量能否界定CRRT的介入时机 A Randomized Controlled study 28例冠脉搭桥术后AKI患者 Early group 尿量30ml/h 持续3h , 14 cases Late group 尿量20ml/h 持续2h, 14 cases 86% 14% Early group Late group Souichi. Hemodialysis International. 2004; 8: 320--325 RIFLE分期与CRRT介入时机 Chih-Chung Shiao. Critical Care. 2009, 13:R171 25% 27% 13% Chronic kidney disease（CKD） Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of CKD include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Levey AS, et al. Ann Intern Med. 2003; 139: 137-147. Kidney damage Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies. Persistent proteinuria is the principal marker of kidney damage. An albumin– creatinine ratio greater than 30 mg/g in two of three spot urine specimens is usually considered abnormal. Levey AS, et al. Kidney Int. 2005; 67: 2089-2100. NKF. Am J Kidney Dis. 2002; 39: S1-246. GFR can be estimated from calibrated serum creatinine and estimating equations, such as the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula. The MDRD formula is recommended by Euro