aDivision of Urology, Spectrum Health, Michigan State University, Grand Rapids, Michigan bGlickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio cUniversity of California, San Diego, California, USA.
Curr Opin Urol. 2014 Mar;24(2):127-34. doi: 10.1097/MOU.0000000000000029.
Chronic kidney disease (CKD) has generally been characterized functionally as a glomerular filtration rate (GFR) less than 60 ml/min/1.73 m², without accounting for cause, signs of structural damage, or relative risk of sequelae. Recently released guidelines define CKD as abnormalities of kidney structure or function, present for more than 3 months. We review the recent literature about CKD and its implications for renal surgery.
Most estimates of GFR are based on serum creatinine, after adjusting for age, race, sex, and/or body mass. Recent research indicates that many individuals have GFR values less than 60 ml/min/1.73 m² without other manifestations of CKD. Nephron loss due to normal aging or renal surgery (CKD-S) may have lower likelihood of CKD progression, and may infer better survival, compared to individuals with the same degree of CKD due to medical causes. Patients with mild and moderate CKD due to surgical nephron loss may benefit from an alternative measurement method of renal function such as cystatin-C-derived or directly measured GFR.
CKD includes a diverse group of individuals with reduced GFR from a variety of causes. Classification of CKD according to GFR, albuminuria, and cause, may improve the management of patients with reduced GFR, as some causes (e.g., nephrectomy and aging) appear to be associated with a relatively low risk of progression.
慢性肾脏病（CKD）通常从肾小球滤过率（GFR）<60ml/min/1.73m²的功能方面进行特征描述，而没有考虑病因、结构损伤的迹象或后果的相对风险。最近发布的指南将 CKD 定义为肾脏结构或功能异常，持续时间超过 3 个月。我们综述了关于 CKD 的最新文献及其对肾脏手术的影响。
大多数 GFR 估计值基于血清肌酐，经过年龄、种族、性别和/或体重调整。最近的研究表明，许多个体的 GFR 值<60ml/min/1.73m²，但没有其他 CKD 表现。与因医学原因而具有相同程度 CKD 的个体相比，由于正常衰老或肾脏手术导致的肾单位损失（CKD-S）可能具有较低的 CKD 进展可能性，并可能推断出更好的生存。因手术性肾单位损失而导致轻度和中度 CKD 的患者可能受益于替代肾功能测量方法，如胱抑素 C 衍生或直接测量的 GFR。
CKD 包括一组因多种原因导致 GFR 降低的不同人群。根据 GFR、白蛋白尿和病因对 CKD 进行分类，可能会改善 GFR 降低患者的管理，因为某些病因（如肾切除术和衰老）似乎与进展的相对低风险相关。
