Johnson Cynda Ann, Levey Andrew S, Coresh Josef, Levin Adeera, Lau Joseph, Eknoyan Garabed
Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
Am Fam Physician. 2004 Sep 15;70(6):1091-7.
The Kidney Disease Outcome Quality Initiative of the National Kidney Foundation published clinical practice guidelines on chronic kidney disease in February 2002. Of the 15 guidelines, the first six are of greatest relevance to family physicians. Part II of this two-part review covers guidelines 4, 5, and 6. Glomerular filtration rate is the best overall indicator of kidney function. It is superior to the serum creatinine level, which varies with age, sex, and race and often does not reflect kidney function accurately. The glomerular filtration rate can be estimated using prediction equations that take into account the serum creatinine level and some or all of specific variables (age, sex, race, body size). In many patients, estimates of the glomerular filtration rate can replace 24-hour urine collections for creatinine clearance measurements. Urine dipsticks generally are acceptable for detecting proteinuria. To quantify proteinuria, the ratio of protein or albumin to creatinine in an untimed (spot) urine sample is an accurate alternative to measurement of protein excretion in a 24-hour urine collection. Patients with persistent proteinuria have chronic kidney disease. Other techniques for evaluating patients with chronic kidney disease include examination of urinary sediment, urine dipstick testing for red and white blood cells, and imaging studies of the kidneys (especially ultrasonography). These techniques also can help determine the underlying cause of chronic kidney disease. Family physicians should weigh the value of the National Kidney Foundation guidelines for their clinical practice based on the strength of evidence and perceived cost-effectiveness until additional evidence becomes available on the usefulness of the recommended quality indicators.
美国国家肾脏基金会的肾脏病预后质量倡议组织于2002年2月发布了慢性肾脏病临床实践指南。在这15项指南中,前六项与家庭医生最为相关。本两部分综述的第二部分涵盖指南4、5和6。肾小球滤过率是肾功能的最佳综合指标。它优于血清肌酐水平,血清肌酐水平会因年龄、性别和种族而有所不同,且常常不能准确反映肾功能。肾小球滤过率可以使用考虑血清肌酐水平以及部分或所有特定变量(年龄、性别、种族、体型)的预测方程来估算。在许多患者中,肾小球滤过率的估算值可以替代24小时尿肌酐清除率测定。尿试纸条通常可用于检测蛋白尿。为了量化蛋白尿,随机(即时)尿样中蛋白质或白蛋白与肌酐的比值是24小时尿蛋白排泄量测定的准确替代方法。持续性蛋白尿患者患有慢性肾脏病。评估慢性肾脏病患者的其他技术包括检查尿沉渣、尿试纸条检测红细胞和白细胞以及肾脏影像学检查(尤其是超声检查)。这些技术也有助于确定慢性肾脏病的潜在病因。在有更多证据证明推荐的质量指标的有用性之前,家庭医生应根据证据强度和预期成本效益来权衡美国国家肾脏基金会指南对其临床实践的价值。