內(nèi)科學(xué)英文課件：Chronic Renal Failure

ChronicRenalFailureACourseforStudentsChronicRenalFailureACourseChronicrenalfailure

theend-stageofCKDandisdefinedasseverelyreducedkidneyfunctionortreatmentwithdialysisChronicrenalfailure

theOverview1)Definition,etiologyandmechanismofchronicrenalfailure(CRF)2)Clinical

manifestations3)Diagnosisanddifferentialdiagnosis4)PreventionandtreatmentOverview1)Definition,etiolog

definition,etiologyandmechanismofchronicrenalfailure(CRF)

Overview1definition,etiologyanddefinitionandclassificationofCKDandCRFepidemiologyandetiologyofCKDandCRFriskfactorsforCKDandprogressionofCKDmechanismofCRF

ContentsdefinitionandclassificationDefinition

andclassificationChronicrenalfailure:theend-stageofCKDandisdefinedasseverelyreducedkidneyfunctionortreatmentwithdialysisEnd-stagerenaldisease(ESRD):generallyreferstochronickidneyfailuretreatedwitheitherdialysisortransplantationDefinitionandclassificationDefinition

andclassificationDefinitionofCKD:Accordingto2012KDIGOguidelinesstructuralorfunctionalabnormalitiesforthreeormoremonthswithorwithoutdecreasedglomerularfiltrationrate(GFR)manifestbyeitherpathologicalabnormalitiesothermarkersofkidneydamage,includingabnormalitiesinthecompositionofbloodorurine,orabnormalitiesinimagingtestsorGFR<60

mL/min

per1.73m2

forthreeormoremonthswithorwithoutothersignsofkidneydamage,asdescribedabove.DefinitionandclassificationDClassificationofCKDDefinition

andclassificationGFRCategories(ml/min/1.73m2)CKD1≥90CKD260-89CKD330-59CKD415-29CKD5<15ClassificationofCKDDefiniticreatinineclearanceCockcroft-Gaultequation:

(140-age)

x

leanbodyweight[kg]

CCr

(mL/min)

=

———————————————————

Cr

[mg/dL]

x

72estimatedGFRTheModificationofDietinRenalDisease(MDRD)studyequations：Equation1：GFR

=

170x

(SCr[mg/dL])exp[-0.999]

x

(Age)exp[-0.176]

x

(BUN

[mg/dL])exp[-0.170]

x

(Alb

[g/dL])exp[+0.318]

x

(0.762iffemale)

x

(1.18ifblack)Equation4GFR

=

186.3

x

SCr(exp[-1.154])

x

Age(exp[-0.203])

x

(0.742iffemale)

x

(1.21ifblack)EstimationofGFRcreatinineclearanceestimaTheincidenceandprevalenceinpatientswithESRD（1978-2009）2011ARDUSRDSPreventionofCKDbecomingapublichealthproblemTheincidenceandprevalenceiEpidemiologyandEtiologyIncreasingPrevalenceofEnd-StageRenalDisease(ESRD):IntheUnitedStates,thenumberhasincreasedfromapproximately10,000beneficiariesin1973to615,899asofDecember31,2011.HealthcareResources:Medicarecostsperpersonperyearweremorethan$75,000overall,rangingfrom$32,922fortransplantpatientsto$87,945forthosereceivinghemodialysistherapy.SignificantMortalityandMorbidityandaReducedQualityofLifeEpidemiologyandEtiologyIncreEpidemiologyandEtiologyDiabeticnephropathyHypertensivenephrosclerosisGlomerulonephritisCausesofCRF:2011USRDSdatashows:Inchina:PrimaryGlomerulonephritisHypertensivenephrosclerosisDiabeticnephropathyEpidemiologyandEtiologyDiabUSRDS2011ADRIncidentcounts&rates,byprimarydiagnosisPrevalentcounts&rates,byprimarydiagnosisEpidemiologyandEtiologyUSRDS2011ADRIncidentcounts2014年度上海市透析登記報(bào)告上海市ESRD患者原發(fā)病因

（2014年）2014年度上海市透析登記報(bào)告上海市ESRD患者原發(fā)病因

（RiskFactorsforCKDandProgressionofCKDHistoryofdiabetes,CVD,hypertension,hyperlipidemia,obesity,metabolicsyndrome,smoking,humanimmunodeficiencyvirus(HIV)orhepatitisCvirusinfection,andmalignancyFamilyhistoryofkidneydiseaseTreatmentwithpotentiallynephrotoxicdrugsRiskfactorsforCKDareasfollows:RiskFactorsforCKDandProgrRiskFactorsforCKDandProgressionofCKDGreaterproteinuriaHigherbloodpressureBlackraceLowerserumhigh-densitylipoprotein(HDL)cholesterolLowerlevelsofserumtransferrinOthersenvironmentalexposuressuchaslead,smoking,diabetes,abnormalglucoseconcentration,metabolicsyndrome,possiblysomeanalgesicagents,obesityRiskfactorsforprogressionofCKDareasfollows:RiskFactorsforCKDandProgr

initiatingmechanismsspecifictotheunderlyingetiologyasetofprogressivemechanisms，irrespectiveofunderlyingetiologyhyperfiltrationoftheremainingnephronhypertrophyoftheremainingnephronPathophysiologyofCKDMechanisminitiatingmechanismsspecifiMaintainbonestructurevitaminDcalciumbalancehematopoiesissynthesisofEPOmaintainbloodpressure

waterbalanceremovesodiumRegulatingbloodPHsynthesisandreabsorptionofbicarbonateMaintainheartfunctionpotassiumbalanceRemovemetabolicendproductsremoveureacreatinineKidneyFunctionMaintainbonestructurevitaminHyperfiltrationintheremainingnormalnephrons:

adaptivehyperfiltrationHypermetabolismintheremainingnormalnephronsEpithelial-mesenchymaltransformationoftubularepithelialcells

Eytokines:IL-1,MCP-1,AngiotensinIIetalUremictoxins:urea,nitrogenouscompounds,PTHetal.

MechanismMechanismoftheprogressionofCRFHyperfiltrationintheremainiOverview

ClinicalManifestations2OverviewClinicalManifestatio1、Fluid,electrolyteandacid-basedisorders2、Bonediseaseanddisordersofcalciumandphosohatemetabolism3、Cardiovascularabnormalities4、Hematologicabnormalities5、Neuromuscularabnormalities6、Gastrointestinalandnutritionalabnormalities7、Endocrine-metabolicdisturbances8、DermatologicabnormalitiesClinicalManifestations1、Fluid,electrolyteandacidSodiumandWaterHomeostasis1、Fluid,electrolyteandacid-basedisorders1.SodiumandWaterretentiondisruptedglomerulotubularintakeofsodiumexceeditsexcretionWaterintakedoesnotexceedthecapacityforfreewaterclearance2.VolumedepletionGastrointestinallossOverzealousdiuretic3.HyponatremiaSodiumandWaterHomeostasis1、1、Fluid,electrolyteandacid-basedisorders1.Pathophysiologyhigh-potassiumdietproteincatabolismhemolysis,hemorrhage,transfusionofstoredredbloodcellsmetabolicacidosishypoaldosteronism(administrationofanACEinhibitororARB)potassium-sparingdiuretics

PotassiumHomeostasis1、Fluid,electrolyteandacid-1、Fluid,electrolyteandacid-basedisorders2.ClinicalManifestationsSeveremuscleweaknessorparalysisCardiacmanifestations:

cardiacconductionabnormalities,andcardiacarrhythmias

Electrocardiogram(ECG)changes:

tallpeakedTwaves,

lengtheningofthePRintervalandQRSduration,QRSwidensfurthertoasinewavepatternnormaltallpeakedTwaves,

lengtheningofQTduration

lengtheningofQRSduration1、Fluid,electrolyteandacid-

MetabolicAcidosis1、Fluid,electrolyteandacid-basedisordersPathophysiologyIncreasedacidgenerationLessammoniaproductionDiminishedrenalacidexcretionMetabolicAcidosis1、Fluid,2、BonediseaseanddisordersofcalciumandphosohatemetabolismCKD-mineralandbonedisorder(CKD-MBD)manifestedbyeitheroneoracombinationofthefollowingthreecomponents:Abnormalitiesofcalcium,phosphorus,parathyroidhormone(PTH),orvitaminDmetabolismAbnormalitiesinboneturnover,mineralization,volumelineargrowth,orstrengthExtraskeletalcalcification2、Bonediseaseanddisorderso新的機(jī)制補(bǔ)充并強(qiáng)調(diào)：血磷正常（通過FGF23的代償）FGF23過量（代償升高）1,25D缺乏（FGF23影響）高磷血癥（失代償，排磷不暢，磷潴留）Klotho減少FGFR表達(dá)下降CaSR表達(dá)下降VDR表達(dá)下降最終，Ca、VD、FGF23三條調(diào)節(jié)通路均失效，PTH升高與此同時(shí)IsakovaTandWolfM.KidneyInt2010;78,947-949123458762、Bonediseaseanddisordersofcalciumandphosohatemetabolism新的機(jī)制補(bǔ)充并強(qiáng)調(diào)：與此同時(shí)IsakovaTandWo2、BonediseaseanddisordersofcalciumandphosohatemetabolismOsteitisfibrosacystica

—highboneturnoverAdynamicbonedisease

—lowboneturnoverOsteomalacia

—lowboneturnoverincombinationwithabnormalmineralizationMixeduremicosteodystrophy—eitherhighorlowboneturnoverandabnormalmineralizationClassificationofbonediseases2、Bonediseaseanddisorderso2、Bonediseaseanddisordersofcalciumandphosohatemetabolism

vascularcalcificationsoft-tissuecalcificationExtraskeletalcalcificationOthercomplicationscalciphylaxis

vascularocclusionextensivevascularcalcification2、Bonediseaseanddisorderso

患者，男，55歲，CKD5期，非透析，冠脈CaS為493.5注：箭頭所指為鈣質(zhì)沉積：A左冠狀動(dòng)脈鈣化；B左冠狀動(dòng)脈和右冠狀動(dòng)脈鈣化vascularcalcification患者，男，55歲，CKD5期，非透析，冠脈C3、CardiovascularabnormalitiesCardiovasculardisease(CVD)isthemaincomplicationsofpatientswithchronickidneydisease(CKD)andthemostcommoncauseofdeath,especiallyinpatientswithESRD3、Cardiovascularabnormalities3、CardiovascularabnormalitiesIschemicVascularDisease

occlusivecoronaryheartcerebrovascularperipheralvasculardiseasestraditional(classic)hypertension,hypervolemia,dyslipidemia,sympatheticoveractivitiyandhyperhomocysteinemia

nontraditional(CKD-related)anemia,hyperphosphatemia,hyperparathyroidism,sleepapnea,generalizedinflammationRiskFactors3、Cardiovascularabnormalities3、CardiovascularabnormalitiesHeartFailuremyocardialischemicdiseaseleftventricularhypertrophysaltandwaterretention“l(fā)ow-pressure”pulmonaryedemaChestx-ray:a“batwing”distributionofalveolaredema3、CardiovascularabnormalitiesPericardialdiseasePericardialpainwithrespiratoryaccentuation,AccompaniedbyafrictionrubAccompaniedornotAccompaniedbytheaccumulationofpericardialfluidPericardialdiseasePericardia4、HematologicabnormalitiesAnemianormocyticandnormochromicreducedproductionoferythropoietinbythekidneyIronandfolatedeficiencyseverehyperparathyroidismacuteandchronicinflammationshortenedredcellsurvival4、HematologicabnormalitiesAne4、HematologicabnormalitiesAbnormalHemostasisprolongedbleedingtimedecreasedactivityofplateletfactorIIIabnormalplateletaggregationandadhesivenessimpairedprothrombinconsumptionincreasedtendencytobleedingandbruisingprolongedbleedingfromsurgicalincisionsspontaneousgastrointestinalbleedingClinicalmanifestations4、HematologicabnormalitiesAbn5、Neuromuscularabnormalitiescentralnervoussystem(CNS),peripheralneuropathyretainednitrogenousmetabolitesandmiddlemoleculesaswellasPTHCNS:milddisturbancesinmemoryandconcentrationandsleepdisturbanceneuromuscularirritability:hiccups,cramps,andfasciculationsortwitchingofmusclesAsterixis,myoclonus,andchoreasensorynerves:restlesslegssyndromemotornerves:muscleweakness5、Neuromuscularabnormalities6、Gastrointestinalandnutritionalabnormalitiesuremicfatcor,aurine-likeodoronthebreathgastritispepticdiseasemucosalulcerationsconstipationanorexia,nausea,andvomiting6、Gastrointestinalandnutriti7、Endocrine-metabolicdisturbancesglucosemetabolisminwomen,lowestrogen,menstrualabnormalitiesandinabilitytocarrypregnanciestoterminmen,reducedplasmatestosteronelevelssexualdysfunction,oligospermiainadolescentchildren,impairedsexualmaturation7、Endocrine-metabolicdisturba8、Dermatologicabnormalitiesanemiapallordefectivehemostasisecchymosesandhematomascalciumphosphatedepositionandsecondaryhyperparathyroidismpruritus,excoriationsdepositionofpigmentedmetabolitesorurochromesyellowdiscolorationureauremicfrost8、DermatologicabnormalitiesaOverview

DiagnosisandDifferentialDiagnosis3OverviewDiagnosisandDiffereDiagnosisofCRFhistoryreviewofmedicationsphysicalexamination(

signsofvolumecontractionorthepresencesofproliferativediabeticretinopathy)testing(serumcreatininefortheestimationoftheglomerularfiltrationrate(GFR),urinalysisandthequantificationofurineproteinoralbumin(byprotein-to-creatinineratiooralbumin-to-creatinineratio)DiagnosisofCRFhistoryDifferentialDiagnosisofCRFCRFtoPrerenalaxotemiaCRFtoacuterenalfailure(ARF)BultrasoundCRFtoacuteprogressionofCRFCRFtoacuteonchronicrenalfailureDifferentialDiagnosisofCRF

preventionandtreatment4Overviewpreventionandtreatment4Over內(nèi)科學(xué)英文課件：ChronicRenalFailureTreatment1)Reversiblecausesofrenalfailure2)Slowingtherateofprogression3)Treatmentofthecomplicationsofrenalfailure4)TreatmentofthecomplicationsofESRD5)RenalreplacementtherapyTreatment1)Reversiblecauses1、ReversiblecausesofrenalfailureDecreasedrenalperfusionHypovolemia(vomiting,diarrhea,diureticuse,bleeding)hypotension(myocardialdysfunctionorpericardialdisease)infection(sepsis)administrationofdrugs(nonsteroidalantiinflammatorydrugs[NSAIDs]andangiotensinconvertingenzyme[ACE]inhibitors)1、Reversiblecausesofrenalf1、ReversiblecausesofrenalfailureAdministrationofnephrotoxicdrugsaminoglycosideantibiotics(particularlywithunadjusteddoses),NSAIDsradiographiccontrastmaterialUrinarytractobstructionrenalultrasonography1、Reversiblecausesofrenalf2、Slowingtherateofprogressiontreatmentoftheunderlyingdiseasetreatmentofsecondaryfactors1)bloodpressurecontrol2)attainingtheproteinuriagoal3)proteinrestriction4)statintherapy5)smokingcessation6)treatmentofchronicmetabolicacidosiswithsupplementalbicarbonate2、Slowingtherateofprogress2、Slowingtherateofprogression1)

Bloodpressurecontrolpatientswithdiabeticnephropathyorproteinuria(＞0.5～1g/d

):＜130/80mmHgratherthan140/90mmHgpatientswithnonproteinuria

(＜0.5g/d

):atleast＜140/90mmHgAntihepertentiondrugs:angiotensinconvertingenzyme(ACE)inhibitorsangiotensinIIreceptorblockers(ARBs)calciumchannelblockersaldosteroneantagonists2、Slowingtherateofprogress2、Slowingtherateofprogression2)

ProteinrestrictionMechanismofprotein-inducedhyperfiltrationHormonaleffects

Glucagon,insulin-likegrowthfactorI(IGF-I),kininsIntrarenaleffects

tubuloglomerularfeedbackbalanceOthereffectsprofibroticfactors,infiltratingT-cellsinthekidney2、Slowingtherateofprogress2、Slowingtherateofprogression2)

ProteinrestrictionAccordingto2012KDIGOguidelines:proteinofhighbiologicvalue0.8

g/kg

perday

2、Slowingtherateofprogress2、Slowingtherateofprogression3)

ProteinuriaGoal2004K/DOQI

:＜500to1000

mg/g

creatinine(＜1g/d)patientswiththenephroticsyndrome：atleast50to60percentfrombaselinevaluesplus

proteinexcretionlessthan3.5

g/day2、Slowingtherateofprogress2、Slowingtherateofprogression4)

StatintherapyBeneficialeffectsonvesselstiffeningandendothelialfunctionanti-inflammatoryreducedalbuminuria?theeffectonprogressionofCKDisconflictingstatintherapyforcardiovascularprotectionTheeffectofStatintherapy？2、SlowingtherateofprogressEffectofpravastatinoninflammationandurinaryproteinexcretioninpatientswithchronicglomerulonephritisEffectofpravastatinoninflaEffectofpravastatinoninflammationandurinaryproteinexcretioninpatientswithchronicglomerulonephritisEffectofpravastatinoninflaEffectofpravastatinoninflammationandurinaryproteinexcretioninpatientswithchronicglomerulonephritisEffectofpravastatinoninfla2、Slowingtherateofprogression5)

SmokingCessationsmokingcorrelatewithanenhancedriskofdevelopingkidneydisease(primarilynephrosclerosis)increasingtherateofprogressionamongthosewithexistingCKD2、Slowingtherateofprogress2、Slowingtherateofprogression6)

TreatmentofChronicMetabolicAcidosisAlowermeanrateofdeclineofcreatinineclearanceAlowerriskofhavinganannualdeclineincreatinineclearanceAlowerriskofend-stagerenaldisease(ESRD)

benefitsofbicarbonatesupplementation2、Slowingtherateofprogress3、Treatmentofthecomplicationsofrenalfailure1)Volumeoverload2)Hyperkalemia3)Metabolicacidosis4)Mineralandbonedisorders(MBD)5)Hypertension6)Anemia7)Dyslipidemia8)Sexualdysfunction3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure1)

Volume

overloadadjustmentsindietaryintakeofsaltuseofloopdiuretics3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure2)

Hyperkalemiadietaryrestrictionofpotassiumavoidanceofpotassiumsupplements(ocultsources,suchasdietarysubstitutes)Stoppingtheuseofpotassium-retainingmedications(especiallyACEinhibitorsorARBS)ortheuseofkalemiadiureticsPotassium-bindingresinsIntractablehyperkalemiaisanindicationofdialysis3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure3)

Metabolicacidosisalkalisupplementationsodiumbicarbonatesodiumcitratemaintaintheserumbicarbonateconcentrationinthenormalrange(23to29

meq/L)typicallyinadoseof0.5to1

meq/kg

perday.

Sodiumcitrateshouldbeavoidedinpatientstakingaluminum-containingantacids3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure4)Mineralandbonedisorders(MBD)

preventionphosphate-bindingagents:calciumcarbonateandcalciumacetate,sevelamercalcitriolcalcium–sensingreceptor:calcimimetic

3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure5)

Hypertensionvolumecontrol:saltrestrictiondiureticsantihypertensiveagents:

ACEinhibition,angiotensinreceptorblockade3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure6)

AnemiarecombinanthumanEPOmodifiedEPOproducts:darbepoetin-alphaironsupplementation3、Treatmentofthecomplicatio3、Treatmentofthecomplicationsofrenalfailure7)

Dyslipidemia

therapeuticlifestylechanges(fastingtriglyceridelevels>5.65

mmol/L)dietarymodificationweightreductionincreasedphysicalactivityreductioninalcoholintake

fibratesstatins3、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDMalnutritionUremicbleedingPericarditisUremicneuropathyThyroiddysfunctionInfectionandvaccination4、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDMalnutrition

Nutritionbalanceprovidapproximately30to35kcal/kgperday4、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDUremicbleedingNospecifictherapyisrequiredinasymptomaticpatientsInpatientsundergoingasurgicalorinvasiveprocedure(arenalbiopsy)correctionofanemiatheadministrationofdesmopressin(dDAVP),cryoprecipitate,estrogeninitiationofdialysis4、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDPericarditis

Dialysisresolutionofchestpaindecreaseinthesizeofthepericardialeffusion4、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDUremicneuropathyabsoluteindicationsfortheinitiationofdialysisTheextentofrecoveryisdirectlyrelatedtothedegreeandextentofdysfunctionpriortotheinitiationofdialysis4、Treatmentofthecomplicatio4、TreatmentofthecomplicationsofESRDInfectionandvaccination2012KDIGOguidelines:AdultswithallstagesofCKDshouldbeofferedannualvaccinationwithinfluenzavirus,unlesscontraindicated.Adultswithstage4and5CKDwhoareathighriskofprogressionofCKDshouldbeimmunizedagainsthepatitisB,andtheresponseconfirmedbyimmunologictesting.AdultswithCKDstages4and5shouldbevaccinatedwithpolyvalentpneumococcalvaccine,unlesscontraindicated.Patientswhohavereceivedpneumococcalvaccinationshouldbeofferedrevaccinationwithinfiveyears.4、Treatmentofthecomplicatio5、IndicationsforrenalreplacementtherapyPericarditisorpleuritis(urgentindication).Progressiveuremicencephalopathyorneuropathy,withsignssuchasconfusion,asterixis,myoclonus,wristorfootdrop,orinseverecases,seizures(urgentindication).Aclinicallysignificantbleedingdiathesisattributabletouremia(urgentindication).Fluidoverloadrefractorytodiuretics.Hypertensionpoorlyresponsivetoantihypertensivemedications.Persistentmetabolicdisturbancesthatarerefractorytomedicaltherapy

(hyperkalemia,hyponatremia,metabolicacidosis,hypercalcemia,hypocalcemia,andhyperphosphatemia).Persistentnauseaandvomiting.Evidenceofmalnutrition.5、IndicationsforrenalreplacHemodialysisHemodialysisHemodialysisHemodialysisreliesontheprinciplesofsolutediffusionacrossasemipermeablemembrane.Movementofmetabolicwasteproducts.Threetimesaweek,eachtimefor3～5hours.HemodialysisHemodialysisre內(nèi)科學(xué)英文課件：ChronicRenalFailureSchemaforhemodialysis內(nèi)科學(xué)英文課件：ChronicRenalFailure內(nèi)科學(xué)英文課件：ChronicRenalFailureTheRationaleofthehemodialysis內(nèi)科學(xué)英文課件：ChronicRenalFailure內(nèi)科學(xué)英文課件：ChronicRenalFailure內(nèi)科學(xué)英文課件：ChronicRenalFailurePeritonealDialysisPeritonealDialysisPeritonealdialysisAswithhemodialysis,Peritonealdialysiscanpurifytheblood.Thedifferenceisthatinperitonealdialysis,peritonealmenbraneusedasasemipermeablemembranetoremovemetabolicwasteproductsPeritonealdialysisAswithh內(nèi)科學(xué)英文課件：ChronicRenalFailure1.continuousambulatoryperitonealdialysis(CAPD)2.Automatedperitonealdialysis(APD)

TWOMainTypesofPeritonealdialysis1.continuousambulatoryperitRenalTransplantation內(nèi)科學(xué)英文課件：ChronicRenalFailure內(nèi)科學(xué)英文課件：ChronicRenalFailureRenalTransplantation

Donors:deceaseddonor;livingdonorRecipientselectionMatchingtests:ABObloodgrouplymphocytestoxicitytesthumanleukocyteantigen(HLA)panelreactiveantibody[PRA]RenalTransplantationDonors:ImmunosuppressivetherapyGlucocorticoids(Prednisone)CyclosporineorTacrolimus(FK-506)AzathioprineorMycophenolatemofetilCommonlyusedtripletherapyPrednisone+CsAorFK-506+AzaorMMFComplicationsInfection;MalignancyRenalTransplantationImmunosuppressivetherapyChoosethesuitablewayofrenalreplacementtherapyChoosethesuitablewayofren內(nèi)科學(xué)英文課件：ChronicRenalFailure

Thanksforattention

ChronicRenalFailureACourseforStudentsChronicRenalFailureACourseChronicrenalfailure

theend-stageofCKDandisdefinedasseverelyreducedkidneyfunctionortreatmentwithdialysisChronicrenalfailure

theOverview1)Definition,etiologyandmechanismofchronicrenalfailure(CRF)2)Clinical

manifestations3)Diagnosisanddifferentialdiagnosis4)PreventionandtreatmentOverview1)Definition,etiolog

definition,etiologyandmechanismofchronicrenalfailure(CRF)

Overview1definition,etiologyanddefinitionandclassificationofCKDandCRFepidemiologyandetiologyofCKDandCRFriskfactorsforCKDandprogressionofCKDmechanismofCRF

ContentsdefinitionandclassificationDefinition

andclassificationChronicrenalfailure:theend-stageofCKDandisdefinedasseverelyreducedkidneyfunctionortreatmentwithdialysisEnd-stagerenaldisease(ESRD):generallyreferstochronickidneyfailuretreatedwitheitherdialysisortransplantationDefinitionandclassificationDefinition

andclassificationDefinitionofCKD:Accordingto2012KDIGOguidelinesstructuralorfunctionalabnormalitiesforthreeormoremonthswithorwithoutdecreasedglomerularfiltrationrate(GFR)manifestbyeitherpathologicalabnormalitiesothermarkersofkidneydamage,includingabnormalitiesinthecompositionofbloodorurine,orabnormalitiesinimagingtestsorGFR<60

mL/min

per1.73m2

forthreeormoremonthswithorwithoutothersignsofkidneydamage,asdescribedabove.DefinitionandclassificationDClassificationofCKDDefinition

andclassificationGFRCategories(ml/min/1.73m2)CKD1≥90CKD260-89CKD330-59CKD415-29CKD5<15ClassificationofCKDDefiniticreatinineclearanceCockcroft-Gaultequation:

(140-age)

x

leanbodyweight[kg]

CCr

(mL/min)

=

———————————————————

Cr

[mg/dL]

x

72estimatedGFRTheModificationofDietinRenalDisease(MDRD)studyequations：Equation1：GFR

=

170x

(SCr[mg/dL])exp[-0.999]

x

(Age)exp[-0.176]

x

(BUN

[mg/dL])exp[-0.170]

x

(Alb

[g/dL])exp[+0.318]

x

(0.762iffemale)

x

(1.18ifblack)Equation4GFR

=

186.3

x

SCr(exp[-1.154])

x

Age(exp[-0.203])

x

(0.742iffemale)

x

(1.21ifblack)EstimationofGFRcreatinineclearanceestimaTheincidenceandprevalenceinpatientswithESRD（1978-2009）2011ARDUSRDSPreventionofCKDbecomingapublichealthproblemTheincidenceandprevalenceiEpidemiologyandEtiologyIncreasingPrevalenceofEnd-StageRenalDisease(ESRD):IntheUnitedStates,thenumberhasincreasedfromapproximately10,000beneficiariesin1973to615,899asofDecember31,2011.HealthcareResources:Medicarecostsperpersonperyearweremorethan$75,000overall,rangingfrom$32,922fortransplantpatientsto$87,945forthosereceivinghemodialysistherapy.SignificantMortalityandMorbidityandaReducedQualityofLifeEpidemiologyandEtiologyIncreEpidemiologyandEtiologyDiabeticnephropathyHypertensivenephrosclerosisGlomerulonephritisCausesofCRF:2011USRDSdatashows:Inchina:PrimaryGlomerulonephritisHypertensivenephrosclerosisDiabeticnephropathyEpidemiologyandEtiologyDiabUSRDS2011ADRIncidentcounts&rates,byprimarydiagnosisPrevalentcounts&rates,byprimarydiagnosisEpidemiologyandEtiologyUSRDS2011ADRIncidentcounts2014年度上海市透析登記報(bào)告上海市ESRD患者原發(fā)病因

（2014年）2014年度上海市透析登記報(bào)告上海市ESRD患者原發(fā)病因

（RiskFactorsforCKDandProgressionofCKDHistoryofdiabetes,CVD,hypertension,hyperlipidemia,obesity,metabolicsyndrome,smoking,humanimmunodeficiencyvirus(HIV)orhepatitisCvirusinfection,andmalignancyFamilyhistoryofkidneydiseaseTreatm