Romagnani Paola, Agarwal Rajiv, Chan Juliana C N, Levin Adeera, Kalyesubula Robert, Karam Sabine, Nangaku Masaomi, Rodríguez-Iturbe Bernardo, Anders Hans-Joachim
Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
Nat Rev Dis Primers. 2025 Jan 30;11(1):8. doi: 10.1038/s41572-024-00589-9.
Chronic kidney disease (CKD) is defined by persistent abnormalities of kidney function or structure that have consequences for the health. A progressive decline of excretory kidney function has effects on body homeostasis. CKD is tightly associated with accelerated cardiovascular disease and severe infections, and with premature death. Kidney failure without access to kidney replacement therapy is fatal - a reality in many regions of the world. CKD can be the consequence of a single cause, but CKD in adults frequently relates rather to sequential injuries accumulating over the life course or to the presence of concomitant risk factors. The shared pathomechanism of CKD progression is the irreversible loss of kidney cells or nephrons together with haemodynamic and metabolic overload of the remaining nephrons, leading to further loss of kidney cells or nephrons. The management of patients with CKD focuses on early detection and on controlling all modifiable risk factors. This approach includes reducing the overload of the remaining nephrons with inhibitors of the renin-angiotensin system and the sodium-glucose transporter 2, as well as disease-specific drug interventions, if available. Hypertension, anaemia, metabolic acidosis and secondary hyperparathyroidism contribute to cardiovascular morbidity and reduced quality of life, and require diagnosis and treatment.
慢性肾脏病（CKD）的定义是肾脏功能或结构持续异常并对健康产生影响。肾脏排泄功能的进行性下降会影响身体的内环境稳定。CKD与心血管疾病加速进展、严重感染以及过早死亡密切相关。无法接受肾脏替代治疗的肾衰竭是致命的——这在世界许多地区都是现实。CKD可能是单一病因所致，但成人CKD往往与一生中累积的连续性损伤或并存的危险因素有关。CKD进展的共同病理机制是肾细胞或肾单位的不可逆丧失，以及剩余肾单位的血流动力学和代谢负荷过重，进而导致肾细胞或肾单位进一步丧失。CKD患者的管理重点在于早期发现以及控制所有可改变的危险因素。这种方法包括使用肾素-血管紧张素系统抑制剂和钠-葡萄糖协同转运蛋白2抑制剂减轻剩余肾单位的负荷，以及在有可用药物时进行针对疾病的药物干预。高血压、贫血、代谢性酸中毒和继发性甲状旁腺功能亢进会导致心血管疾病发病率增加和生活质量下降，需要进行诊断和治疗。
