在白蛋白尿和估计肾小球滤过率联合检测的 CKD 患者中，慢性肾脏病的检出率较高。

High chronic nephropathy detection yield in CKD subjects identified by the combination of albuminuria and estimated GFR.

机构信息

Division of Nephrology and Dialysis, Department of Internal Medicine and Medical Specialties, Renal Program, Columbus-Gemelli University Hospital, Catholic University, Rome, Italy.

出版信息

Nephrol Dial Transplant. 2012 Feb;27(2):746-51. doi: 10.1093/ndt/gfr360. Epub 2011 Jul 7.

DOI:10.1093/ndt/gfr360

PMID:21737518

Abstract

BACKGROUND AND OBJECTIVES

Epidemiological studies have shown that the burden of chronic kidney disease (CKD) is huge. CKD is a non-specific diagnosis, however, and it is hard to say which renal disorders comprise the body of CKD diagnosed on the strength of the combination of albuminuria and estimated glomerular filtration rate (eGFR) in epidemiological studies, or just how efficient such studies are in detecting chronic nephropathies.

METHODS

The INCIPE study identified 524 CKD cases (using the K/DOQI definition based on albuminuria and eGFR) in a random sample of 4000 Italians >40 years old, 262 of whom were randomly chosen to be investigated in order to confirm their CKD and complete a diagnostic workup. We a priori defined diagnostic algorithms for 14 renal conditions based on personal family history, medical records, urine tests, kidney ultrasound with colour-Doppler and other tests.

RESULTS

Among the subjects whose CKD was confirmed, a diagnosis of chronic nephropathy was reached in 68% of cases recognized as having either a specific (38%) or an undetermined (30%) kidney disease. Almost 50% of subjects with a specific chronic nephropathy had a diabetic or vascular renal disease. Abnormalities consistent with a chronic nephropathy were found in 50, 68, 70 and 100% of subjects with CKD Stages 1, 2, 3 and 4, respectively. Lone low eGFR and lone microalbuminuria were observed in 20 and 12%, respectively.

CONCLUSION

In Caucasians >40 years old with a confirmed CKD condition, (i) an impressive 68% of subjects have an underlying chronic nephropathy, so eGFR and albuminuria are very efficient in detecting renal diseases; (ii) in 32%, the only disclosed renal abnormalities were a glomerular filtration rate <60 mL/min/1.73 m(2) or microalbuminuria; follow-up studies are needed to clarify whether these abnormalities do really identify a chronic nephropathy or just a cardiovascular risk condition.

摘要

背景与目的

流行病学研究表明，慢性肾脏病（CKD）的负担巨大。然而，CKD 是一种非特异性诊断，很难说在流行病学研究中，基于蛋白尿和估算肾小球滤过率（eGFR）的组合诊断的哪些肾脏疾病构成 CKD，或者这些研究在检测慢性肾病方面的效率有多高。

方法

INCIPE 研究在一个由 4000 名意大利>40 岁的随机样本中发现了 524 例 CKD 病例（使用基于蛋白尿和 eGFR 的 K/DOQI 定义），其中 262 例随机选择进行调查以确认他们的 CKD 并完成诊断检查。我们根据个人家族史、病历、尿液检查、彩色多普勒肾脏超声和其他检查，预先为 14 种肾脏疾病定义了诊断算法。

结果

在确认 CKD 的患者中，68%的患者被诊断为慢性肾病，其中 38%的患者被诊断为特定（30%的患者被诊断为未确定）肾脏疾病。几乎 50%的有特定慢性肾病的患者患有糖尿病或血管性肾病。在 CKD 1 期、2 期、3 期和 4 期的患者中，分别有 50%、68%、70%和 100%的患者发现异常符合慢性肾病，而仅有低 eGFR 和仅微量白蛋白尿的患者分别占 20%和 12%。

结论

在>40 岁的白种人中，患有确诊 CKD 的患者中，（i）令人印象深刻的 68%的患者患有潜在的慢性肾病，因此 eGFR 和白蛋白尿在检测肾脏疾病方面非常有效；（ii）在 32%的患者中，唯一发现的肾脏异常是肾小球滤过率<60 mL/min/1.73 m2或微量白蛋白尿；需要进行随访研究以明确这些异常是否确实识别出慢性肾病，还是仅仅识别出心血管风险状况。