Vaslaki L
Soproni Erzsébet Kórház, Belgyógyászati Osztály és Fresenius Dializis Centrum.
Orv Hetil. 1998 Dec 13;139(50):2995-9.
The course of chronic renal failure is generally progressive and mediated by several factors that operate in combination. Several extrarenal events which may cause transient or permanent deterioration of renal function, are important, because their correction may slow the progression of renal disease e.g. volume disorders, infection, nephrotoxic agents. In progression of chronic renal disease leading factors are hypertension, proteinuria and high protein/phosphorus intake. Number of evidence suggests that ameliorating hypertension, reducing proteinuria slow the progression of chronic renal failure. Clinical studies in diabetic nephropathy demonstrated that the renoprotective effect of ACE inhibitors was independent of their effect of systemic blood pressure. In ESRD patients access for renal replacement therapy should be obtained as early as possible. An A-V fistula may take several weeks to mature especially in diabetic or elderly patients. Early dialysis has been advocated in diabetic patients. In general, patients can start ESRD therapy when residual kidney function drops to 5-10% of normal value. High quality of dialysis should be provided to the uremic patient with respect of successful renal transplantation.
慢性肾衰竭的病程通常呈进行性，由多种因素共同作用介导。一些可能导致肾功能短暂或永久性恶化的肾外事件很重要，因为纠正这些因素可能会减缓肾脏疾病的进展，例如容量紊乱、感染、肾毒性药物。在慢性肾脏病进展过程中，主要因素是高血压、蛋白尿和高蛋白/磷摄入。大量证据表明，改善高血压、减少蛋白尿可减缓慢性肾衰竭的进展。糖尿病肾病的临床研究表明，ACE抑制剂的肾脏保护作用独立于其对全身血压的影响。对于终末期肾病（ESRD）患者，应尽早获得肾脏替代治疗途径。动静脉内瘘可能需要数周时间才能成熟，尤其是在糖尿病患者或老年患者中。糖尿病患者主张早期透析。一般来说，当残余肾功能降至正常值的5-10%时，患者可开始ESRD治疗。就成功进行肾移植而言，应向尿毒症患者提供高质量的透析。
