Bastos Marcus Gomes, Kirsztajn Gianna Mastroianni
Universidade Federal de Juiz de Fora, Brazil.
J Bras Nefrol. 2011 Mar;33(1):93-108.
At present, chronic kidney disease (CKD) is broadly defined on the basis of changes in the glomerular filtration rate and/or the presence of parenchymal damage present for at least 3 months. Although the diagnosis of CKD is now quite straightforward, the proportion of patients with end-stage renal disease seen by a nephrologist for the first time immediately before the initiation of dialysis is still unacceptable. Early diagnosis and immediate nephrology referral are key steps in management because enable predialysis education, allow implementation of preventive measures that delay or even halt progression of CKD to end stage renal disease, as well as decrease initial morbidity and mortality. In this review, we discuss the complexity of CKD and the multiplicity of interventions currently recommended in its secondary prevention, different models of healthcare delivery, and examine the rational and outcomes of patients followed in interdisciplinary care clinics.
目前，慢性肾脏病（CKD）主要根据肾小球滤过率的变化和/或存在至少3个月的实质损伤来广泛定义。尽管CKD的诊断现在相当直接，但肾病科医生在透析开始前首次接诊的终末期肾病患者比例仍然不可接受。早期诊断和立即转诊至肾病科是管理的关键步骤，因为这能进行透析前教育，允许实施延缓甚至阻止CKD进展至终末期肾病的预防措施，并降低初始发病率和死亡率。在本综述中，我们讨论了CKD的复杂性、目前在其次级预防中推荐的多种干预措施、不同的医疗服务提供模式，并研究了在跨学科护理诊所随访的患者的合理性和结局。
