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Chronic kidney disease 总被引:1,自引:0,他引:1
Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function. The 2002 guidelines for definition and classification of this disease represented an important shift towards its recognition as a worldwide public health problem that should be managed in its early stages by general internists. Disease and management are classified according to stages of disease severity, which are assessed from glomerular filtration rate (GFR) and albuminuria, and clinical diagnosis (cause and pathology). Chronic kidney disease can be detected with routine laboratory tests, and some treatments can prevent development and slow disease progression, reduce complications of decreased GFR and risk of cardiovascular disease, and improve survival and quality of life. In this Seminar we discuss disease burden, recommendations for assessment and management, and future challenges. We emphasise clinical practice guidelines, clinical trials, and areas of uncertainty. 相似文献
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Iseki K 《Internal medicine (Tokyo, Japan)》2008,47(8):681-689
Chronic kidney disease (CKD) is defined as either kidney damage with urine, imaging, and histologic abnormalities, or a low estimated glomerular filtration rate (GFR) for more than 3 months. The GFR is calculated using either the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula. CKD is a risk factor for end-stage renal disease (ESRD) and cardiovascular disease. In Japan, the prevalence of ESRD is increasing and is currently more than 2,000 per million population. More than 40% of incident ESRD is due to diabetes mellitus (DM). The prevalence of a low GFR (< 60 ml/min/1.73 m(2)) is estimated to be 20% of the adult population. Studies based on several community-based screening programs suggest that Japan has a higher prevalence of CKD than any other country. Early detection and treatment of CKD are necessary to decrease the incidence of ESRD and cardiovascular disease. 相似文献
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Menopause is derived from the Greek words men (month) and pauses (cessation) and means permanent cessation of menstruation after the loss of ovarian activity. Chronic kidney disease (CKD) has recently been associated with cardiovascular events in several studies. CKD patients have a heavy burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. In this review, the association of CKD and cardiovascular disease (CVD), as well as of osteoporosis in postmenopausal women is discussed. CKD mineral and bone disorder, characterized by disturbances of calcium/phosphate/parathyroid hormone, bone abnormalities and vascular and soft tissue calcification, is highly prevalent in CKD and is a strong, independent predictor of bone fracture, CVD and death. Estrogen has been shown to: (a) decrease the expression of angiotensin type 1 receptors in vasculature and kidneys; (b) reduce the expression and activity of angiotensin-converting enzyme, and (c) cause the release of angiotensinogen substrate from the liver. However, the degree of activation or suppression of the renin-angiotensin-aldosterone system by estrogen has not been clearly established. Clinical data on the effects of estrogen therapy on bone mineral densities are extremely limited in the ESRD population. CVD is the most common cause of death in postmenopausal women with CKD and many contributing factors have been explored. Future research for prevention of CVD in postmenopausal women with CKD would focus on the biology of vascular calcification as well as bone loss. 相似文献
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Boon Wee Teo Gek Cher Chan Christopher Cheang Han Leo Jam Chin Tay YookChin Chia Saulat Siddique Yuda Turana ChenHuan Chen HaoMin Cheng Satoshi Hoshide Huynh Van Minh Guru Prasad Sogunuru TzungDau Wang Kazuomi Kario 《Journal of clinical hypertension (Greenwich, Conn.)》2021,23(3):475
The countries of Asia are home to multiple ethnicities. There are ethnic differences in diet, culture, and attitudes towards health screening, access to care, and treatment of chronic diseases. Chronic kidney disease (CKD) and end‐stage kidney disease (ESKD) have rising incidence and prevalence due to increased affliction with non‐communicable diseases of diabetes and hypertension. To prevent the expensive complications of ESKD, one of the most important risk factors to control is hypertension in patients with CKD. We performed a narrative review on the prevalence of CKD in patients with hypertension, the prevalence and control of hypertension in patients with CKD, and the dietary sodium intake in CKD populations. 相似文献
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Yee J 《Geriatrics》2008,63(3):30-37
Chronic kidney disease (CKD) is a silent disorder that is under-recognized. It is most often diagnosed by biochemical abnormalities. The combination of age, ethnicity, gender, and serum creatinine yields the best overall index of kidney function, and the estimated glomerular filtration rate (GFR) must be readily available for clinical practitioners to facilitate identification of CKD. The detection of persistent proteinuria also heralds the presence of CKD, but this sign is often ignored. A detailed case study is presented to demonstrate the evolution of CKD and its insidious progression to a multifaceted and complex disorder. Delineation of the complications of CKD permits the adaptation of a collaborative action plan between primary care physicians and nephrologists, and sample approaches are outlined. 相似文献
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《Journal of the American Society of Hypertension》2007,1(3):178-184
Chronic kidney disease (CKD) is a global public health concern, and there is emerging a strong relationship between CKD and increased cardiovascular disease (CVD) risk. CKD in the presence of other co-morbidities such as type 2 diabetes mellitus (T2DM) and hypertension (HTN) can lead to early progression to end-stage renal disease (ESRD/stage V CKD) and confer a greater risk for CVD morbidity and mortality. CVD events are the leading cause of premature death in patients with CKD, even before their progression to ESRD, with the rate of CVD progression being twice as common compared with the general population. The higher mortality from CVD persists even after adjusting for most of the traditional risk factors, suggesting the possible contributions of uremia-related, nontraditional risk factors. This has led to the current understanding that the pathophysiology of CVD in CKD involves a complex interplay of both the traditional as well as nontraditional, uremia-related risk factors. This review will elaborate on the pathophysiology of CVD in CKD and will discuss the role of microalbuminuria (MAU)-proteinuria as a potential diagnostic and prognostic tool for CVD in CKD risk assessment. 相似文献
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Weidner Kathrin Behnes Michael Schupp Tobias Hoppner Jorge Ansari Uzair Mueller Julian Lindner Simon Borggrefe Martin Kim Seung-hyun Huseyinov Aydin Ellguth Dominik Akin Muharrem Meininghaus Dirk Große Bertsch Thomas Taton Gabriel Bollow Armin Reichelt Thomas Engelke Niko Reiser Linda Akin Ibrahim 《Journal of interventional cardiac electrophysiology》2022,63(1):13-20
Journal of Interventional Cardiac Electrophysiology - The study sought to assess the prognostic impact of chronic kidney disease (CKD) in patients with electrical storm (ES). ES represents a... 相似文献
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48岁男性,乙型病毒性肝炎肝硬化12年。亲体肝移植术后3年,术后采用他克莫司+霉酚酸酯+泼尼松抗排斥治疗。近1年患者出现尿检异常伴血清肌酐升高。肾活检示75%的肾小球废弃,肾小管间质弥漫纤维化,肾间质血管病变重,免疫荧光检查证实IgA与C3弥漫分布于肾小球系膜区。诊断考虑肝移植后慢性肾脏病变。 相似文献
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The worldwide rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal failure necessitating renal replacement therapy is threatening to reach epidemic proportions over the next decade, and only a small number of countries have robust economies able to meet the challenges posed. A change in global approach to CKD from treatment of end-stage renal disease (ESRD) to much more aggressive primary and secondary prevention is therefore imperative. In this Seminar, we examine the epidemiology of CKD worldwide, with emphasis on early detection and prevention, and the feasibility of methods for detection and primary prevention of CKD. We also review the risk factors and markers of progressive CKD. We explore current understanding of the mechanisms underlying renal scarring leading to ESRD to inform on current and future interventions as well as evidence relating to interventions to slow the progression of CKD. Finally, we make strategic recommendations based on future research to stem the worldwide growth of CKD. Consideration is given to health economics. A global and concerted approach to CKD must be adopted in both more and less developed countries to avoid a major catastrophe. 相似文献
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