医技学院(华盛顿医疗手册培训肾脏疾病).pptVIP

* Chronic Kidney Disease 4) UTI or obstruction should be considered in all patients with an unexplained drop in renal function. 5) renal artery stenosis ,Renal vein thrombosis TREATMENT 1) avoidance of risk factors (listed above) 2) dietary modification 3) blood pressure control 4) adequate treatment of the associated conditions (listed below) 5) preparation for renal replacement therapy. Chronic Kidney Disease Dietary restrictions Sodium restriction to less than 3 g/d . Heart failure or refractory hypertension less than 2 g/d 2. Fluid restrictions are generally not required in CKD patients 3. Potassium should be restricted to 60 mEq/d 4. Dietary phosphate restriction should be to 800 to 1,000 mg/d. Chronic Kidney Disease Hypertension Uncontrolled hypertension accelerates the rate of decline of renal function patients with CKD is 130/80. ACE inhibitors and ARBs a 30% rise in serum creatinine should be anticipated and tolerated; a further rise should prompt a search for possible renal artery stenosis. The creatinine and serum potassium should be checked approximately 1 to 2 weeks Diuretics Chronic Kidney Disease Anemia normocytic anemia transferrin saturation is 20% or the ferritin level is 200 mg/dL, consideration should be given to iron repletion Erythropoietic hormones such as epoetin and darbepoetin (达依泊汀) Chronic Kidney Disease Renal osteodystrophy and secondary hyperparathyroidism Renal osteodystrophy： Osteitis fibrosa Adynamic bone disease Osteomalacia hyperparathyroidism ：starting in stage 3, vitamin D deficiency, low calcium, and elevated phosphate 1. Deficient stores (25-OH vitamin D 30 ng/mL) oral ergocalciferol or cholecalciferol Chronic Kidney Disease 2. Phosphate control calcium carbonate， calcium acetat