CRF慢性肾衰竭.docVIP

The importance of Chronic Renal Failure Worldwide, the prevalence流行，普及 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血浆 creatinine肌酐 concentration浓度 can be used to monitor监测 renal function when GFR50ml/min Mass screening大规模筛选 of plasma creatinine cannot provide early detection察觉 of renal diseases in the general population 对策：治疗原发病；评估和延缓进展速度；降低心血管危险；避免急性肾损害。 继发性的甲旁亢，GFR下降，磷的清除减少，导致高磷、低钙、PTH增加。 moderately适度地。钙的吸收降低；deficiency缺乏、不足。促红素不足导致贫血。Referral呈交 高磷血症；代酸；有高钾血症的倾向 azotaemia氮尿症 Causes of CRF Glomerular diseases account for占 60% of CRF Diabetic nephropathy account for 10-15% of CRF (in USA about 50%) Hypertension: 10-15% Polycystic多囊的 kidney diseases: 5% Obstructive uropathy尿道疾病: 3-4% Lupus狼疮 nephropathy: 2-3% Undermined Origin: 5-10% Evolution of CRF Glomerular肾小球的 diseases will be decreased Diabetic and hypertensive nephropathy↑ Chronic nephrotoxicity by environmental pollutants污染物, drugs and herbs中草药↑ Incidence of ESRD终末期肾病（end-stage renal disease）: 100-200 per million Clinic manifestation of CRF Deterioration恶化 of renal function is invariable不变的 once GFR is reduced by more than 25% ?Serial连续的 plots图 of the reciprocal倒数 of cr vs对. time follows a straight line Often remain asymptomatic无症状的 when GFR=25% Uraemic尿毒症的 syndrome 不舒服;搔痒厌食症restless .焦躁不安的；运动不止的 hiccough 打嗝 pallor n. (尤指因疾病、恐惧所导致的脸色的)苍白infertility不孕amenorrhea 闭经;月经不调impair vt.损害，损伤，削弱 polyuria多尿症Clinical Diagnosis of CRF Acute or chronic? Often presents acutely when GFR suddenly drops from 20% to 10% or less To assess评估 the severity严重性 of renal impairment损伤 To elucidate解释 the causes of renal failure To ascertain查明 whether the renal failure is acute, or acute-on-chronic To assess the patient for renal replacement therapy Clinical Investigations调查(研究)