内科学慢性肾脏疾病(中英文).ppt

* * * * * As we know, CKD can be divided into 5 stages based on the estimated GFR: Stage 1 to 5. If patients presented with eGFR less than 15 ml/min, the patient had to depended on dialysis. However, if he/she presented with CKD stage 1-4, the disease could be improved or reversed. * * Chronic renal failure can be caused by any disease of urinary tract system which could distruct the normal and function. * * * * * * * * * KDIGO指南对何时应开始EPO治疗进行了详细的描述： 对于非透析成年患者而言，Hb ≥ 10g/dl时不建议开始ESA治疗（2D）；Hb10g/dl，建议根据Hb下降速度，对于铁剂治疗的反应，需要输血治疗的风险，使用ESA治疗的风险，目前的贫血症状等个体化情况决定是否开始ESA治疗（2C） 而血透患者由于Hb下降速率快，如果不及时治疗，Hb会迅速跌至8g/dl以下，而且在Hb低于9g/dl后，输血的风险也较高。 所以应该及时使用ESA以防止Hb水平跌至9g/dl以下 建议在Hb 9~10g/dl时及时开始ESA治疗（2B） * * * * * * * * * * Key message A clear illustration of the inappropriateness of sCr as a sensitive indicator of kidney function. * * * * * * * * * * Treatment of complications 1、Hypertension: 目标血压值130-139/80-85mmHg ——2009 ESH指南 高血压高危、低危靶目标均为SBP140mmHg ——2013 ESH指南 * 不同人群靶目标血压不同 BP Target in CKD 中国高血压防治指南 伴有慢性肾脏疾病、糖尿病，或病情稳定的冠心病或脑血管病的高血压患者治疗更宜个体化，一般＜130/80?mmHg 2013ESH/ESC高血压管理指南 无论是高危还是低危的高血压患者，收缩压的目标值全部是＜140mmHg 除糖尿病患者舒张压靶目标值调整到 85mmHg 外，其他患者的舒张压靶目标值均为＜90mmHg * European Heart Journal.doi:10.1093/eurheartj/eht151 Antihypertensive Drugs restriction of sodium ACEI/ARB CCB β-blocker ? -blocker diuretic * Restriction of water and sodium Furosemide Vascular dilation Digoxins 2、Heart Failure * Blood purification Correction of electrolytes and acid-base disturbance Improvement of anemia Pericarditis: Increase dialysis frequency or time Heparin free dialysis Surgery * 3、Anemia: Recombinant human erythropoietin 50-100 u/kg tiw, ih target: Hb 110-120g/L, Hct 30-35% Iron: iv or po Folic acid * 4、CKD-MBD: Recover the imbalance of Ca, P （calcium? phosphate ? PTH ?） restriction of intake phosphate binding Vitamin D supplement Partial parathyroidectomy * Fluid and electrolytes Na intake: 3 g/d patients with hypertension, edema, or he