Brosnahan Godela, Fraer Mony
Department of Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Health System, Little Rock, AR 72205, USA.
South Med J. 2010 Feb;103(2):140-6. doi: 10.1097/SMJ.0b013e3181c99438.
Chronic kidney disease has become a major public health problem due to its high prevalence, its exorbitant cost, and large reductions in life expectancy and quality of life of affected people. Seventy percent of cases of end-stage renal disease are due to diabetes and hypertension, conditions which are usually managed by primary care providers. Other risk factors are cardiovascular disease, obesity, smoking, family history of kidney disease, and age greater than 55 years. Patients with these risk factors should be evaluated for the presence of chronic kidney disease during their primary care visits, because effective treatments for slowing progression are available, particularly if instituted early. Chronic kidney disease can be diagnosed by simple blood and urine tests, as recommended in guidelines issued by the National Kidney Foundation. This article begins with a case vignette, representing a common clinical scenario from a general internist's practice. We then review the definition and classification of chronic kidney disease, the epidemiology, etiology, and interconnections with cardiovascular disease. We discuss the guidelines for screening and laboratory testing, as well as the limitations of current assessment tools. A subsequent article will review evidence-based management of chronic kidney disease.
由于慢性肾脏病患病率高、治疗费用高昂，且会大幅缩短患者预期寿命并降低其生活质量，它已成为一个主要的公共卫生问题。70%的终末期肾病病例归因于糖尿病和高血压，而这些病症通常由初级保健提供者进行管理。其他风险因素包括心血管疾病、肥胖、吸烟、肾病家族史以及年龄大于55岁。具有这些风险因素的患者在进行初级保健就诊时应接受慢性肾脏病检查，因为有有效的减缓疾病进展的治疗方法，尤其是在早期开始治疗时。按照美国国家肾脏基金会发布的指南建议，通过简单的血液和尿液检查即可诊断慢性肾脏病。本文开篇是一个病例 vignette，代表了普通内科医生临床实践中的常见情景。然后我们将回顾慢性肾脏病的定义和分类、流行病学、病因以及与心血管疾病的相互联系。我们将讨论筛查和实验室检测指南，以及当前评估工具的局限性。后续文章将回顾慢性肾脏病的循证管理。
