慢性肾脏病患者疾病管理教学讲解.ppt

MANAGEMENT OF THE PATIENT WITH CHRONIC KIDNEY DISEASE;Outline;What is Chronic Kidney Disease?;Defining CKD;Estimates of U.S. Chronic Kidney Disease Population in 2000;Stages of CKD;Prevalence of CKD;AGE AND RACE;Familial Influences;Estimation of GFR; Calculation of GFR; The Cockcroft-Gault calculation ;MDRD GFR Formula* 170 x [SCr]-0.999 x [Age]-0.176 x [0.762 if female] x [1.180 if black] x [Alb]+0.318 Modified MDRD Formula 186.338 x [SCr]-1.154 x [Age]-0.203 x [1.212 if black] x [0.742 if female]; 84 F 22 M 66 M 66 F Wt (kg) 45.5 104.5 77.2 71.8 Screat 1.2 1.2 1.2 1.2 ;Urine Protein / Creatinine Ratio;Fig 1 Correlation between ln spot morning urine protein:creatinine ratio and log 24 hour urinary protein in 177 non-diabetic patients with chronic nephropathies and persistent clinical proteinuria;Physiologic Changes in ChronicKidney Disease;Anatomic and Histologic Features Due to Glomerular Hypertension;Pathogenesis of Secondary Glomerulosclerosis;Hypertension in CKD;;Effects of Various Anti-hypertensives on Glomerular Capillary Pressure;Number of Medications to Achieve Goal BP in 5 Trials of DM/Renal Disease ;A Hierarchy of Agents;Volume Management-Diuretics;Natriuretic Response to Furosemide at Different Levels of Renal Function;Diuretic Tolerance;Algorithm for Diuretic Use;Alterations in Bone and Mineral Metabolism;;;Calcium and Phosphorus Balance:National Kidney Foundation Recommendations (KDOQI);Calcium and Phosphorus BalanceKDOQI Recommendations;Calcium and Phosphorus BalanceKDOQI Recommendations;Calcium and Phosphorus Balance:Limit Phosphorus intake to 0.8-1.0 g/d;Use of Phosphate binders;Use of Phosphate binders;Vitamin D Sterols;KDOQI Recommendations for use of Vitamin D sterols;The Calcimemetics;Treatment of Secondary Hyperparathyroidism;;Complications of Long Term Calcium and Phosphorus imbalance;Parathyroidectomy;Anemia of