_Kidney Disease慢性肾脏病（PPT35）课件.ppt

Chronic Kidney Disease Sandeep Vetteth Chronic Kidney Disease A 54 year old woman is evaluated for a Cr of 1.3; 18 months ago it was 0.9. She has a 5 year history of DM 2, dyslipidemia and HTN well controlled with lisinopril, HCTZ, and atenelol. She is also on glipizide and simvastatin. Hemoglobin is normal. What is the most appropriate for this patient? 24 hour collection for proteinuria Kidney USG Measurement of Urine micro albumin SPEP Measurement of HbA1C Chronic Kidney Disease In the United States, there is a rising incidence and prevalence of Kidney Disease. Nearly 350,000 of these are on dialysis. Also, there is an increasing prevalence of earlier stages of chronic kidney disease which unfortunately is “under-diagnosed” and “under-treated” in the United States. In 2000, the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) Advisory Board approved development of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of chronic kidney disease. Stages of Chronic Kidney Disease Causes of End Stage Renal Disease Chronic Kidney Disease Many terms are used to describe states of reduced glomerular filtration (GFR) not requiring renal replacement therapy; Chronic Renal Insufficiency Chronic Renal Failure Renal Insufficiency Pre dialysis renal disease Pre uremia Renal dysfunction They are imprecise poorly defined. Measurement of GFR Gold standard is Inulin Iothalamate. Creatinine Clearance calculated by timed (24h) urine collection along with serum collection for Creatinine. Overestimate GFR when CKD is severe due to an increase in tubular secretion of creatinine. This factor can be corrected by cimetidine. Estimation of GFR More than 10 formulae for estimation of GFR. MDRD most widely accepted now. CKD – Risk Factors Diabetes Mellitus Hypertension Cardiovascular Disease Obesity Metabolic Syndrome Age and Race Acute Kidney Injury Malignancy Family history of CKD Kidney Stones Inf