复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）肾与尿路_CKD-4

革山院 Chronic Kidney Diseases (CKD Minmin zhang Division of Nephrology ashan Hospital, Fudan Univeristy

Chronic Kidney Diseases (CKD) Minmin Zhang Division of Nephrology Huashan Hospital, Fudan Univeristy

革山院 Contents Definition, stage, epidemiology of CKD Causes and pathophysiology of CKD Clinical and laboratory manifestations of CKD Treatment of cKd

Contents • Definition, stage, epidemiology of CKD • Causes and pathophysiology of CKD • Clinical and laboratory manifestations of CKD • Treatment of CKD

革山院 Chronic Kidney Diseases(CKD) Definition (NKF-K/) CKD presence of kidney damage gFR 3 months ≥>3 months Loss of kidney function Kidney damage

Chronic Kidney Diseases (CKD) ---Definition (NKF-K/DOQI) •GFR <60 mL/min •with or without kidney damage • ≥3 months CKD •presence of kidney damage •pathologic abnormalities •markers of kidney damage • imaging tests •≥3 months Loss of kidney function Kidney damage

革山院 ) Defining“ Kidney Damage” a Pathologic abnormalities By Radiology (Us, CT, Mr, etc)e.g Multiple cysts consistent with PKd 上 xtensive scarring Small kidneys REMEMBER: Renal masses or complex cysts that are not simple should be referred to a UROLOGIST!! By Histology--ie, renal biopsy

Defining ―Kidney Damage‖  Pathologic Abnormalities  By Radiology (US, CT, MR, etc)--e.g.  Multiple cysts consistent with PKD  Extensive scarring  Small kidneys  REMEMBER: Renal masses or complex cysts that are not simple should be referred to a UROLOGIST!!  By Histology--ie, renal biopsy

革山院 ) Defining“ Kidney Damage” Markers of Kidney Damage Proteinuria Microalbuminuria Hematuria(especially when seen with proteinuria) Isolated hematuria has a long differential: infection stone malignancy, etc Casts(especially with cellular elements

Defining ―Kidney Damage‖  Markers of Kidney Damage  Proteinuria  Microalbuminuria  Hematuria (especially when seen with proteinuria)  Isolated hematuria has a long differential: infection, stone, malignancy, etc.  Casts (especially with cellular elements)

革山院 Definition Chronic kidney disease( CKD) Chronic renal failure (CrF) End stage renal diseases (ESrD) Uremia

Definition • Chronic kidney disease (CKD) • Chronic renal failure (CRF) • End stage renal diseases (ESRD) • Uremia

革山院 Definition Chronic kidney disease(CKd) A spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in GFR A spectrum of clinical problems beginning with abnormalities detectable only by laboratory testing to a late stage, labeled uremia

Definition • Chronic kidney disease (CKD) – A spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in GFR – A spectrum of clinical problems beginning with abnormalities detectable only by laboratory testing to a late stage, labeled uremia

革山院 Definition Chronic renal failure(Crf) a pathophysiologic process with multiple causes that lasts >3 months and results in progressive, irreversible attrition of the number and function of nephrons Typically corresponds to CKd stages 3-5 Frequently leads to end-stage renal disease (ESrD)

Definition • Chronic renal failure (CRF) – A pathophysiologic process with multiple causes that lasts > 3 months and results in progressive, irreversible attrition of the number and function of nephrons – Typically corresponds to CKD stages 3–5 – Frequently leads to end-stage renal disease (ESRD)

革山院 Definition End stage renal diseases ( esrd) Clinical state in which irreversible loss of endogenous renal function has occurred Patients are permanently dependent on renal replacement therapy to avoid life-threatening uremia CKD Stage 5 Uremia a clinical syndrome reflecting dysfunction of all organ systems due to untreated or undertreated acute or chronic renal failure

Definition • End stage renal diseases (ESRD) – Clinical state in which irreversible loss of endogenous renal function has occurred – Patients are permanently dependent on renal replacement therapy to avoid life-threatening uremia. – CKD Stage 5 • Uremia – A clinical syndrome reflecting dysfunction of all organ systems due to untreated or undertreated acute or chronic renal failure

Stage and prevalence of cKd GFR Prevalence Stage Description (m/min/1.73 N m (1000s) Kidney Damage 1 with normal or个 ≥90 5,9003.3 GFR Kidney damage 60-89 5,30030 234 with mild↓GFR Moderate√GFR 30-59 7.6004.3 Severe」GFR 15-29 4000.2 Kidney Failure <15 or Dialysis 3000.1

Stage and Prevalence of CKD Stage Description GFR (ml/min/1.73 m2 ) Prevalence N (1000s) % 1 Kidney Damage with Normal or  GFR  90 5,900 3.3 2 Kidney Damage with Mild  GFR 60-89 5,300 3.0 3 Moderate  GFR 30-59 7,600 4.3 4 Severe  GFR 15-29 400 0.2 5 Kidney Failure < 15 or Dialysis 300 0.1