中国慢性肾脏病矿物质和骨异常诊治指南概要

正慢性肾脏病(CKD)是一个全球性的健康问题,中国成人CKD患病率已超过10%。慢性肾脏病矿物质与骨异常(CKD-MBD)是CKD的严重并发症,是CKD患者致残、致死等不良结局的重要原因之一,国际上一些肾脏病组织相继制订了一系列指南用于规范CKD-MBD的诊断和治疗。2013年刘志红教授领导的团队制订了《慢性肾脏病矿物质和骨异常诊治指导》,极大地推动了我国肾脏病学家对CKD-MBD的认识和管理水平,对于改变我国CKD-MBD知晓率低、     

硫代硫酸钠治疗慢性肾脏病患者血管钙化临床应用进展

近年来,慢性肾脏病(CKD)作为世界范围内主要的公共卫生问题受到越来越多的关注.慢性肾脏病矿物质和骨异常(CKD-MBD)是由于CKD的矿物质及骨代谢异常综合征所致,严重地影响了 CKD患者的生存率和生活质量.血管钙化是CKD-MBD的临床表现之一,其包括:动脉内膜钙化、中膜钙化、心脏瓣膜钙化和钙化防御.目前临床上还未...     

更上层楼:慢性肾脏病矿物质与骨异常的诊断和治疗

<正>慢性肾脏病矿物质与骨异常(CKD-MBD)是CKD患者疾病进展过程中常见的并发症之一,也是导致患者死亡的重要原因。对该病症的认识和防治直接关系到CKD患者的生活质量及预后。从1942年我国刘士豪教授首次在国际上提出肾性骨营养不良(renal osteodystrophy)的概念,到时隔六十多年之后,2005年改善全球肾脏病预后组织(KDIGO)将CKD患者表现为钙、磷、甲状旁腺激素(PTH)或维     

CKD-MBD的诊断是否必须依赖骨活检

<正>慢性肾脏病(CKD)已成为全球性公共卫生问题,其发病率日益升高,且预后较差。矿物质代谢异常在CKD 2期即已出现,患者如未得到及时诊治,终将发生代谢性骨病(肾性骨营养不良)。2005年,KDICO将肾性骨营养不良重新定义并扩大诊断为慢性肾脏病矿物质和骨异常(CKD-MBD),包括以下三种异常:(1)钙、磷、甲状旁腺激素和维生素D代谢异常;(2)骨转运、骨矿化、骨容量和骨的生长异常;(3)血管和软组织钙化。其中,肾性骨营养不良特指CKD-MBD中经四环素标记骨活检确诊的一类疾病。由于骨活检属于侵     

拟钙剂能否替代甲状旁腺切除手术

正慢性肾脏病矿物质与骨异常(CKD-MBD)是指慢性肾脏病(CKD)导致的矿物质及骨代谢异常综合征,临床表现为钙、磷、甲状旁腺素(PTH)或维生素D代谢异常,骨转化、矿化、骨量、骨线性生长或骨强度异常,以及血管、心脏瓣膜等软组织钙化。CKD-MBD严重影响患者的生活质量和预后。预防高血磷、维持血钙正常、控制继发     

2017 KDIGO临床实践指南更新:慢性肾脏病矿物质与骨异常诊断、评估、预防和治疗

<正>2009年改善全球肾脏病预后组织(KDIGO)发布了慢性肾脏病矿物质与骨异常(CKD-MBD)诊断、评估、预防和治疗临床实践指南。在随后的几年里,多项随机对照临床试验(RCT)和前瞻性队列研究不断提供新的证据,2013年在西班牙马德里召开了主题为"CKD-MBD:回到未来"研讨会,对2009年版CKD-MBD指南中存在的相关问题和临床证据进行系统梳理。专家组认为2009版大部分推荐仍适用。     

继发性甲状旁腺功能亢进的治疗与进展

慢性肾脏病矿物质与骨异常(chronic kidney diseasemineral and bone disorder, CKD-MBD)是CKD患者常见并发症之一,是由于CKD导致的矿物质及骨代谢异常综合征。临床上可出现以下1项或多项表现:(1)钙、磷、甲状旁腺激素(parathyroid hormone, PTH)或维生素D代谢异常;(2)骨转化、矿化,骨线性生长或骨强度异常;(3)血管或其他软组织     

慢性肾脏病患者高磷血症的治疗

慢性肾脏病(CKD)在全球有很高的患病率和死亡率,我国慢性肾脏病总患病率达10.8％[1],约50％的终末期肾病透析患者有不同程度的心脑血管疾病,在终末期肾衰竭维持血透的患者中因心脑血管疾病导致的死亡率高达50％以上[2].高磷血症可以促进甲状旁腺素(PTH)分泌,导致慢性肾脏病-矿物质和骨异常(CKD-MBD),增加成纤维细胞生长因子,23(FGF-23)的水平,促进血管钙化,增加心血管事件的发生,与慢性肾脏病的病死率密切相关.因此,控制高血磷对于防止慢性肾脏病相关并发症,降低患者死亡率具有重要的意义.     

再谈拟钙剂的临床应用

正继发性甲状旁腺功能亢进症(SHPT)是慢性肾脏病(CKD)患者最常见的并发症之一,严重影响患者的生活质量和生存率。近年来,拟钙剂(西那卡塞和伊特卡塞肽已获准上市)为控制和改善SHPT提供了有效治疗手段,但拟钙剂的临床应用仍有很多需要关注的问题。2018年最新版《中国慢性肾脏病矿物质和骨异常诊治指南》附录CKD患者SHPT治疗流程中,我     

如何评价骨活检在CKD-MBD诊断中的价值

<正>矿物质和骨异常(MBD)是慢性肾脏病(CKD)患者的常见并发症,与心血管疾病发病率和死亡率相关。它包含了生化指标异常、骨代谢异常、心脏瓣膜和血管钙化三个部分,如何早期诊断是治疗CKD-MBD和改善患者预后的关键问题。生化和影像学检查可诊断矿物质代谢紊乱和血管(或血管外)钙化,但骨病的诊断却不容易。尽管部分检查能够预测骨折风险、骨转化情况,也和患者预后相关,但并不能完整评价骨代谢,且肾性骨病的出现可能远远早于实验     

Biochemical Abnormalities in Chronic Kidney Disease–Mineral Bone Disease

Chronic kidney disease?Cmineral and bone disorders (CKD-MBD) is a term introduced by the Kidney Disease: Improving Global Outcomes (KDIGO) work group on mineral and bone disorder as a syndrome of interrelated biochemical, bone, and vascular abnormalities encountered in CKD. Biochemical abnormalities in CKD represent primary indicators for the diagnosis and management of CKD-MBD. This review discusses each abnormality separately, with references to both the Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease and KDIGO Guidelines for Mineral and Bone Disorder. Selected references to the association between biochemical abnormalities and adverse clinical outcomes in CKD population are provided.     

慢性肾脏病评估及管理临床实践指南解读——从K/DOQI到KDIGO

规范合理的评估及管理模式对延缓慢性肾脏病进展、改善患者生存质量具有重要意义。2002年美国国家肾脏基金会所属“肾脏病预后质量倡议”(Kidney Disease Outcomes Quality Initiative,K/DOQI)工作组制定了慢性肾脏疾病(CKD)评估、分期和分层临床实践指南,提出了其评估与管理的概念性框架。2012年国际肾脏病组织“肾脏病：改善全球预后”(Kidney Disease：Improving Global Outcomes,KDIGO)在K/DOQI指南基础上,对慢性肾脏病的分期、进展评估与防治、转诊与诊疗模式等方面进行了细化、修订和更新,颁布了CKD评估及管理临床实践指南。     

慢性肾脏病患者甲状旁腺素的检测和临床应用

肾脏疾病生存质量指导(KDOQI)制定了对慢性肾脏病(CKD)各期的甲状旁腺素(PTH)治疗目标值,建议应常规检测CKD患者的血清PTH水平,并维持在CKD各期相应的目标值范围内。PTH检测结果直接决定着慢性肾脏病患者治疗方案的制定。检测PTH主要采用两种方法,第一代的放射免疫测定法,第二、三代的双抗体识别法。目前在临床应用中广泛使用的是第二、三代检测方法,而检测方法的选择、检测的标准化、检测值的校正是目前PTH检测存在的主要问题。     

Treatment of bone disease in chronic kidney disease and in renal transplant recipients under K/DOQI clinical practice guidelines

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) provides evidence based clinical practice guidelines developed for all phases of kidney disease and related complications, from diagnosis to monitoring and management. Bone disease sets in during the early stages of Chronic Kidney Disease (CKD). Bone disease is observed in almost patients with chronic renal failure and after renal transplantation. Hyperparathyroid (high turnover) bone disease in patients with chronic renal failure is found most frequently followed by mixed osteodystrophy, low-turn over bone disease, and osteomalasia. Ninety to one hundred percent of kidney transplant patients have histological evidence of osteodystrophy and osteopenia (reduction of bone mass) following renal transplantation. Furthermore, osteoporosis is also appeared in many renal transplant recipients. After renal transplantation, renal osteodystrophy generally improves but bone mineral density (BMD) often worsens. When renal bone disease is assessed using a combination of biochemical markers, histology and bone densitometry, early intervention and carefully effective therapies might be reduced the morbidity associated with these common problems.     

Bone health as a co-morbidity of chronic kidney disease

Chronic kidney disease and osteoporosis commonly co-exist in aged patients. Chronic kidney disease affects bone health because of its effect on mineral metabolism in the syndrome, Chronic Kidney Disease Mineral and Bone Disorder, resulting in an increased risk of fractures. Hip fracture risk may be as much as four-fold higher in the worst affected. Tools to estimate fracture risk such as FRAX® and measuring bone density can be used in patients with chronic kidney disease; however, bone density may underestimate fracture risk in this population as it does not give information on bone quality. While osteoporosis treatment in patients with chronic kidney disease stage 1–3 does not differ from the general population, in the absence of Chronic Kidney Disease Mineral and Bone Disorder, patients with disease stage 4–5 require special consideration. It is, however, of the utmost importance that these patients receive pharmacological treatment because of their high risk of fractures.     

合理应用人促红细胞生成素治疗肾性贫血

基因重组人促红细胞生成素(rHuEPO)是治疗肾性贫血的主要药物,2012年改善全球肾脏病预后组织(KDIGO)贫血治疗指南根据最新的研究结果对EPO在慢性肾脏病的应用规范提出了建议。本文将从血红蛋白目标值、EPO治疗的启动时机、给药方案、EPO的反应性等方面进行讨论,探寻更加合理的EPO应用策略。在纠正贫血的过程中,应兼顾EPO治疗的获益和风险。     

Specific Bone and Mineral Disorders in Patients with Chronic Kidney Disease

Bone lesions, collectively known as renal osteodystrophy (ROD), are a common complication of chronic kidney disease (CKD). Besides osteitis fibrosa and mixed lesions, other bone and mineral disorders such as adynamic bone disease, osteomalacia, osteoporosis, dialysis-related amyloidosis, and calcific uremic arteriolopathy are increasingly recognized in patients with CKD. Although bone lesions usually begin early in the course of CKD and are progressive, symptoms and signs such as bone pain and fractures may not occur until the patient is already on maintenance dialysis. More importantly, these disorders are associated with increased risk of cardiovascular disease and mortality in patients with CKD. The term ROD does not reflect the full spectrum of bone pathology or clinical manifestations of bone and mineral disorders in patients with CKD. Accordingly, the National Kidney Foundation and, more recently the Kidney Disease: Improving Global Outcomes, now consider ROD to represent only one measure of the skeletal component of the broader syndrome of chronic kidney disease-mineral and bone disorders in which abnormalities in bone and mineral metabolism or extraskeletal calcification are observed. In this review, we will discuss, in detail, the epidemiology, pathogenesis, histopathology, clinical manifestation, diagnosis, and treatment of these disorders.     

The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD

BACKGROUND/AIMS: The National Kidney Foundation (NKF) recently published new guidelines and clinical practice recommendations for the diagnosis and management of patients with diabetes and chronic kidney disease (CKD). METHODS: Guidelines were developed using an evidence-based approach. When sufficient evidence was lacking, recommendations were developed that reflect expert opinion. RESULTS: Guidelines describe the process for screening and diagnosis of kidney disease in the setting of diabetes and the management of hyperglycemia, hypertension, dyslipidemia, and nutrition. Recommendations describe the management of albuminuria in the normotensive diabetic patient and the potential value of albuminuria as a marker of treatment efficacy; the impact of diabetes and CKD in special populations; the importance of behavioral self-management; and the value of intensive multifaceted intervention in these high risk patients. CONCLUSIONS: The new guidelines and recommendations update and extend the scope of the NKF's Kidney Disease Outcomes Quality Initiative (KDOQI(TM)).     

慢性肾脏病定义及分期系统修订的进展——2012-KDIGO慢性肾脏病临床管理实践指南解读

慢性肾脏病（CKD）是全球性公共卫生问题,自2002年美国国家肾脏基金会（NKF）所属“肾脏病预后质量倡议”（K/DOQI）工作组提出了CKD的定义和分期标准以来,该指南对提高全球CKD患者的诊断、治疗水平及改善预后发挥了重大作用。但是,大量根据K/DOQI-CKD诊断标准进行的临床和流行病学研究证据使人们对于CKD患病率过高、CKD3期比例过高、老年人患病率过高以及肾脏单纯结构异常是否应诊断CKD等诸多问题产生了困惑,继而引发了关于现行定义和分期系统适宜性的争议。对此,国际肾脏病组织“改善全球肾脏病预后组织”（KDIGO）于2012年颁布新指南,调整了CKD的定义,建立了考虑病因、肾小球滤过率（GFR）和尿白蛋白水平的CKD联合分期系统（CGA系统）,制定了危险分层模型以判断预后,推荐应用CKD-EPI公式估算GFR水平等。     

Progrediente Niereninsuffizienz und Proteinurie bei einem 74-j?hrigen Patienten

This case example of a 74-year-old patient with limited kidney function in stage 3 according to KDOQI (Kidney Disease Outcomes Quality Initiative) and proteinuria admitted for in-patient renal biopsy, describes the anamnesis, the clinical findings and the primary diagnostics. In the subsequent diagnostics the kidney biopsy supplied the first evidence of the presence of infiltration of the kidneys by a low malignancy non-Hodgkin B-cell lymphoma which was confirmed by iliac crest biopsy, computed tomography and hematological tests.