Noel Natacha, Gaha Khaled, Rieu Philippe
Service de néphrologie, CHU de Reims, hôpital Robert Debré, 51090 Reims Cedex.
Rev Prat. 2012 Jan;62(1):43-51.
Chronic kidney disease (CKD) is a major public health problem. It is therefore important to slow its progression and to treat its complications. Regardless of the causal nephropathy, arterial hypertension and proteinuria are the major progression factors of CKD. Thus, optimal control of blood pressure, reduction of proteinuria by using rennin angiotension system inhibitors can slow the progression of CKD. This effect can be enhanced by reducing sodium intake. The recent recommendations suggest that blood pressure should not be higher than 130/80 mmHg and proteinuria should not exceed 0,5 g/day. The consequences of advanced stages of the CKD have to be diagnosed and treated early: anemia, abnormal bone metabolism, hyperkalemia, fluid overload, metabolic acidosis... A particular emphasis has to be given to cardiovascular complications and risk factors. Monitoring data are well defined by the actual recommandations. Nephrologist can provide a set of recommended intervention to the primary care physician. The most accepted criterion of initiation of dialysis, in absence of clinic uremic manifestation is a glomerular filtration rate lower than 7 ml/min/1,73m2. Psychological and medical preparation of the patient to dialysis is essential. The possibility of renal transplantation should be evaluated during the following of patient with CKD
慢性肾脏病（CKD）是一个重大的公共卫生问题。因此，减缓其进展并治疗其并发症很重要。无论病因性肾病如何，动脉高血压和蛋白尿都是CKD的主要进展因素。因此，通过使用肾素血管紧张素系统抑制剂来优化血压控制、减少蛋白尿，可以减缓CKD的进展。减少钠摄入可增强这种效果。最近的建议表明，血压不应高于130/80 mmHg，蛋白尿不应超过0.5 g/天。CKD晚期的后果必须尽早诊断和治疗：贫血、骨代谢异常、高钾血症、液体过载、代谢性酸中毒……必须特别重视心血管并发症和危险因素。监测数据由现行建议明确界定。肾病科医生可以向初级保健医生提供一系列推荐的干预措施。在没有临床尿毒症表现的情况下，最被认可的开始透析的标准是肾小球滤过率低于7 ml/min/1.73m²。患者对透析的心理和医疗准备至关重要。对于CKD患者，应在随访期间评估肾移植的可能性。
