肾内科课件 crf教学材料.pptVIP

Diagnosis Fundamental Causes of CRF CGN,DN, LN,HBP-GN, etc. Are there worsening factors? Infection,Hypovolemia Nephrotoxins, Hypertension Tiredness,pregnancy Congestive heart failure urinary tract obstruction Treatment Objective Treatment of fundamental disease and worsening factors of CRF， protect residual?nephrons Treatment Measures to retard the disease progression Dietary Management Protein restriction nondialysis patients 0.6g/kg/d dialysis patients 1g/kg/d Salt and water restriction Potassium restriction Phosphorus restriction Magnesium restriction Protein?content 50g pig 9g An egg 6.5g Milk 220ml 6.6g 50g fish 10g 50g Belt Fish 9g 50g Flour 4.5g 50g Beef 10g 50g rice 3.5g Bean curd 50g 5.5g Treatment:Hypertension Antihypertensive objective If non-dialysis,BP ≤ 130/80mmHg If dialysis,BP ≤140/90mmHg Drugs: ACEI/ARB CCB β -blocker; α-blocker Diuretic Vasodilator? Treatment Control blood glucose,lipid, Uric Acid Reduce urinary protein Treatment of Complication Hyperkalemia In acute cases: Cardiac monitoring Calcium chloride Insulin administration with glucose Bicarbonate An orally or rectally administered ion exchange resin an emergent dialysis if necessary(k＞ 6.5mmol/L ) Metabolic acidosis Base supplements include sodium bicarbonate, Administration of alkali divided into two doses per day Dialysis may be needed in severe metabolic acidosis Recombinant erythropoietin (EPO) stared on 50 units/kg 1- 2/week. EPO can cause or worsen hypertension Iron supplementation it is given if the serum ferritin ＜100μg/ml Ferrous sulfate, 325mg/day Folinic acid and Vitamin supplementation Adequate dialysis Anemia treament Dia