Snyder Susan, Pendergraph Bernadette
Department of Family Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA.
Am Fam Physician. 2005 Nov 1;72(9):1723-32.
Chronic kidney disease affects approximately 19 million adult Americans, and its incidence is increasing rapidly. Diabetes and hypertension are the underlying causes in most cases of chronic kidney disease. Evidence suggests that progression to kidney failure can be delayed or prevented by controlling blood sugar levels and blood pressure and by treating proteinuria. Unfortunately, chronic kidney disease often is overlooked in its earliest, most treatable stages. Guidelines from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommend estimating glomerular filtration rate and screening for albuminuria in patients with risk factors for chronic kidney disease, including diabetes, hypertension, systemic illnesses, age greater than 60 years, and family history of chronic kidney disease. The glomerular filtration rate, calculated by using a prediction equation, detects chronic kidney disease more accurately than does the serum creatinine level alone; the glomerular filtration rate also is used for disease staging. In most clinical situations, analysis of random urine samples to determine the albumin-creatinine or protein-creatinine ratio has replaced analysis of timed urine collections. When chronic kidney disease is detected, an attempt should be made to identify and treat the specific underlying condition(s). The KDOQI guidelines define major treatment goals for all patients with chronic kidney disease. These goals include slowing disease progression, detecting and treating complications, and managing cardiovascular risk factors. Primary care physicians have an important role in detecting chronic kidney disease early, in instituting measures to slow disease progression, and in providing timely referral to a nephrologist.
慢性肾脏病影响着约1900万美国成年人口，且其发病率正在迅速上升。糖尿病和高血压是大多数慢性肾脏病病例的潜在病因。有证据表明，通过控制血糖水平、血压以及治疗蛋白尿，可以延缓或预防病情发展至肾衰竭。不幸的是，慢性肾脏病在其最早且最易治疗的阶段往往被忽视。美国国家肾脏基金会的肾脏病预后质量倡议（KDOQI）指南建议，对患有慢性肾脏病风险因素的患者，包括糖尿病、高血压、全身性疾病、年龄大于60岁以及有慢性肾脏病家族史的患者，估算肾小球滤过率并筛查蛋白尿。通过使用预测方程计算得出的肾小球滤过率，比单独的血清肌酐水平更能准确检测慢性肾脏病；肾小球滤过率也用于疾病分期。在大多数临床情况下，分析随机尿液样本以确定白蛋白 - 肌酐或蛋白 - 肌酐比值已取代了定时尿液收集分析。当检测出慢性肾脏病时，应尝试识别并治疗特定的潜在病症。KDOQI指南为所有慢性肾脏病患者定义了主要治疗目标。这些目标包括减缓疾病进展、检测和治疗并发症以及管理心血管危险因素。初级保健医生在早期检测慢性肾脏病、采取措施减缓疾病进展以及及时转诊至肾病科医生方面发挥着重要作用。
