Lancet:慢性肾脏疾病

2017-03-11 MedSci MedSci原创

慢性肾病(CKD)的定义和分类随着时间的推移一直在发展完善,目前国际上的指导方针对CKD的定义为:在不考虑潜在因素的条件下,表现为肾小球滤过率(GFR)每1.73 m2低于60 mL/min,或者存在肾损伤的标志物,又或者两种状态同时存在超过3个月的肾功能衰退。

慢性肾脏疾病

慢性肾病(CKD)的定义和分类随着时间的推移一直在发展完善,目前国际上的指导方针对CKD的定义为:在不考虑潜在因素的条件下,表现为肾小球滤过率(GFR)每1.73 m2低于60 mL/min,或者存在肾损伤的标志物,又或者两种状态同时存在超过3个月的肾功能衰退。

在所有高、中等收入的国家和许多低收入的国家,糖尿病高血压是导致CKD发生的主要原因。由于在不同国家存在不同的种族和群体等决定因素,CKD的发病率、流行性及发病进程可能受到表观遗传因素的影响。许多人没有症状或只有非特异性的症状,如:昏睡、瘙痒或缺乏食欲。诊断往往发生在检查结构改变之后(尿检和验血),又或者当症状变得严重后。通过对外源性标志物的检测(如:DTPA和iohexol)或者化学反应的评估,可获得的最好的肾功能指标是GFR。出现蛋白尿往往预示着CKD进程的风险增大和死亡。肾组织活检可以观察到病理改变,如:肾小球硬化、管状结构萎缩和间质纤维化,以此能得到CKD的确诊。

CKD的并发症包括:红细胞生成素减少而导致的贫血;红细胞寿命降低和缺铁;维他命D、钙和磷酸盐障碍造成的骨矿化疾病。CKD患者发生过早死亡的概率可能是病程发展到晚期肾病的5-10倍。尽管癌症的发病率和死亡率也在不断增高,但当肾功能日趋衰退,这种死亡风险呈指数增加,最终导致死亡的原因主要归咎于心血管疾病。

CKD患者有关健康的生活质量远远低于普通人群,并随着GFR的衰退而下降。靶向干预治疗某一特殊症状,又或提高患者对生活方式的改变和对疾病的认识,会对CKD患者的生活有积极的改善。然而,对于能够获得疾病治疗机会的不平等性不同程度的影响着贫困群体。

另外,许多国家从提供健康服务到疾病早期干预,而不仅仅是对CKD患者提供治疗的这一理念也在持续不断的发展。

原始出处

Webster AC, Nagler EV, Morton RL, et al. Chronic Kidney Disease. Lancet. 2016 Nov 22. pii: S0140-6736(16)32064-5. doi: 10.1016/S0140-6736(16)32064-5

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    2017-11-11 howi
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    2017-03-12 knowheart

    CKD的并发症包括:红细胞生成素减少而导致的贫血;红细胞寿命降低和缺铁等

    0

  4. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 knowheart

    stop

    0

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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 雅文博武

    学习了很多先进水平

    0

  6. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 thlabcde

    好东西学习了!

    0

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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 明月清辉

    谢谢分享,学习了

    0

  8. 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createdBy=92191944782, createdName=thlabcde, createdTime=Sun Mar 12 08:22:32 CST 2017, time=2017-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179272, encodeId=bf681e927296, content=谢谢分享,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Sun Mar 12 07:55:50 CST 2017, time=2017-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179257, encodeId=a1d11e925723, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Mar 12 07:18:19 CST 2017, time=2017-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179245, encodeId=23ad1e924579, content=提供健康服务到疾病早期干预,而不仅仅是对CKD患者提供治疗的这一理念也在持续不断的发展。, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuF63NQckT5BOaic1el7cRelbpr859YXtZQHQSaWnqZCRPOZzDBcjsBNx7AFefLHh1UvMPS4kPP0BG/0, createdBy=47831990981, createdName=1e1a50a1m36(暂无匿称), createdTime=Sun Mar 12 05:42:54 CST 2017, time=2017-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179235, encodeId=d8cc1e92353f, content=长知识,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 刘煜

    学习了谢谢分享

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 1e1a50a1m36(暂无匿称)

    提供健康服务到疾病早期干预,而不仅仅是对CKD患者提供治疗的这一理念也在持续不断的发展。

    0

  10. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sun Mar 12 03:27:52 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
    2017-03-12 飛歌

    长知识,学习了

    0

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Am J Kidney Dis:缺氧诱导因子脯氨酰羟化酶抑制剂:治疗慢性肾病患者贫血的一种潜在新疗法

红细胞生成刺激剂(ESAs)可以增强血红蛋白水平,减少临床输液需求。自1989年以来,ESAs一直被用作治疗慢性肾病患者贫血的标准疗法。然而,在应用ESAs过程中出现诸多安全因素的考虑,包括日益增加的心血管事件的发生和血管通路的血栓形成。缺氧诱导因子(HIF)脯氨酰羟化酶(PH)抑制剂是一类新型治疗慢性肾病患者贫血的药剂。

盘点:慢性肾病,这些研究你需要了解的!

肾病,人体脏腑之间,内环境与外环境之间均保持着动态平衡。内外界多种致病因素如果破坏了人体的平衡,导致脏腑气血功能失调,病及于肾,则引起肾脏疾病的产生。致肾脏疾病的病因多种多样,如六淫、七情、饮食、劳逸、房劳、药毒、意外伤害等多种内外因素均可致病。并且,在疾病的发生、演变过程,病因和其病理产物常互相作用,互为因果。本文williamhill asia 小编整理了近期慢性肾病相关研究进展,与大家分享。【1】Kidney Int

2015 ERBP临床实践威廉亚洲博彩公司 :3b期或以上老年慢性肾病患者的管理

2016年11月,欧洲肾脏最佳临床实践(ERBP)发布了3b期或更高阶段(eGFR <45 mL/min/1.73 m2)老年慢性肾病患者的管理威廉亚洲博彩公司 。

Am J Kidney Dis:糖尿病和慢性肾病患者的终末期肾病和死亡的风险如何?

在这一个慢性肾脏病合并糖尿病患者的队列中,HbA1c<6%和≥9%与较高的死亡风险相关。在特异性CKD人群中HbA1c水平与ESRD无关,糖尿病相关死亡随着HbA1c水平升高而增加。