CRD防治.pptx

CKD的防治朱佳异慢性肾脏病（CKD）（1）肾脏损伤（结构/功能异常）=3m，GFR下降有或无 -病理检查异常 -肾损伤指标（血、尿成分，影像检查异常）（2）CRF: GFR60ml*(min*1.73m^2)^-1 3m早期病变的监测尽早确定肾脏功能受损程度 -对有肾损害的疾病肾功能尿常规检测 -eGFR值 -ACR（尿微量蛋白/尿肌酐）病程进展的控制肾单位的结构和功能完整性对预后有很大的影响 1）肾小球炎症、萎缩；肾间质纤维化 2）影响因素： -损害肾实质的疾病、外因（糖尿病） -心血管疾病（高血压）?相关危险因素的控制 -贫血、钙磷水平血压的控制 Gansevoort R, Correa-Rotter R, Hemmelgarn B, Jafar TH,Lambers Heerspink HJ,Mann JF,Matsushita K,Wen CP.Chronic kidney disease amplifies cardiovascular risk:impact, mechanisms and prevention. Lancet2013; 382:339–52.Figure 3: Causes of death per chronic kidney disease stage (Canadian data)(A) eGFR stages and (B) albuminuria stages. Data are adjusted per eGFR and albuminuria stage for age and sex tothe WHO world averages in 2000–05.心血管疾病与肾病Figure 2: Life expectancy, according to chronic kidney disease stages (Canadian data)(A) eGFR stages and (B) albuminuria stages. Data are adjusted per eGFR and albuminuria stage for sexto the WHO world average in 2000–05. eGFR=estimated glomerular fi ltration rate.慢性肾病患者为心血管疾病高危人群，需分级、制定特殊临床规范慢性肾病与心血管疾病之间存在双向因果关系；因此预防肾病的一大重点是预防心血管疾病肾病引发的心血管疾病并非单一因素的结果，需特殊干预(eg, the targeting of non-traditional cardiovascular risk factors, early prevention, and multifactorial intervention strategies)炎症的控制：核转录因子NF-kB蛋白尿的控制Wohlfarth V, Drumm K,Mildenberger S, Freudinger R, Gekle M. Protein uptake disturbs collagen homeostasis in proximal tubule-derived cells. Kidney Int Suppl 2003; 84:S103–9.管腔液中蛋白含量的增加激活核转录因子NK-kB等信号通路刺激间质细胞分泌胶原蛋白等，加剧间质的纤维化血脂的控制CRD患者对部分降脂类药物的反应低Atorvastatin对肾的保护作用降脂治疗减少肾功能的损失，但具体效果与药物的特异性有关Novel therapiesRAAS阻断 -ACEi -ARB血糖控制 -DPP-IV inhibitors -钠-葡萄糖同向转运体生理平衡调节 -促红细胞生成素激活剂 -Vit D -降血磷 -尿酸清除Novel targets内皮缩血管肽拮抗剂消炎药Based on data in reference 103 for 30 462 patients. Stratagies-多靶向结合-个人化医疗Parving HH, de Zeeuw D, Cooper ME, Remuzzi G, Liu N,Lunceford J, Shahinfar S,Wong PH, Lyle PA, Rossing P,Brenner BM. ACE gene polymorphism and losartan treatment in type 2 diabetic patients with nephropathy.J Am Soc Nephrol 2008; 19: 771–9.The endThank you for listening!