内科学 慢性肾衰竭-陆福明课件.pptVIP

Chronic Renal Failure 陆福明 复旦大学附属华山医院肾脏科 The importance of Chronic Renal Failure Worldwide, the prevalence of CRF is increasing by more than 5% annually The cost of renal replacement therapy has an increasing impact on health economics in both developed and developing countries Plasma Creatinine and GFR Normal GFR 100-125ml/min/1.73m2 GFR declines by about 1ml/min/1.73m2 /year Plasma creatinine concentration can be used to monitor renal function when GFR50ml/min Mass screening of plasma creatinine cannot provide early detection of renal diseases in the general population Causes of CRF Glomerular diseases account for 60% of CRF Diabetic nephropathy account for 10-15% of CRF (in USA about 50%) Hypertension: 10-15% Polycystic kidney diseases: 5% Obstructive uropathy: 3-4% Lupus nephropathy: 2-3% Undermined Origin: 5-10% Evolution of CRF Glomerular diseases will be decreased Diabetic and hypertensive nephropathy↑ Chronic nephrotoxicity by environmental pollutants, drugs and herbs↑ Incidence of ESRD: 100-200 per million Clinic manifestation of CRF Deterioration of renal function is invariable once GFR is reduced by more than 25% Serial plots of the reciprocal of cr vs. time follows a straight line Often remain asymptomatic when GFR=25% Uraemic syndrome Clinical Diagnosis of CRF Acute or chronic? Often presents acutely when GFR suddenly drops from 20% to 10% or less To assess the severity of renal impairment To elucidate the causes of renal failure To ascertain whether the renal failure is acute, or acute-on-chronic To assess the patient for renal replacement therapy Clinical Investigations The history should include a diligent search for potential nephrotoxic agents A positive family may indicate heredofamilial diseases Pallor, scratch marks, peripheral oedema and palpable masses in the abdomen A full examination is important, especially in patients with diabetes Common Investigations Renal function profile Urinalysis Quantitation of proteinuria Determinat