高血压英文PPT精品课件TherapeuticsinRenal

《高血压英文PPT精品课件TherapeuticsinRenal》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、TherapeuticsinRenalDiseaseDrMichaelClarksonConsultantRenalPhysician–CUHChronicKidneyDiseaseCommonEasytoDiagnoseEffectiveTherapiesAvailableCKDCareSuboptimalSerumCreatinineisaPoorMarkerofGFRMDRDeGFRMDRDequation–ComplexlogrhythmicequationIntegrateskeyvariablesAgeSexCreatinineRaceUreaAlb

2、uminGFRistheacceptedmeasureofkidneyfunctionGFRisdifficulttoinferfromserumcreatininealoneAutomaticreportingidentifiesCKDpatientswithapparently“normal”serumcreatinineReducesbarriertoearlydetectionMDRDeGFRThreesimpletestsidentifyCKDinadultsDipstickUrinalysis–Haematuria/MacroalbuminuriaU

3、rinePCR-Urineproteintocreatinineratioona“spot”urinesample24-hoururinecollectionsareNOTneededeGFR-EstimatedGFRfromserumcreatinineusingtheMDRDequationSpotRatios!24hourcollectionscumbersomeExcretionofcreatinineandproteinisreasonablyconstantthroughoutthedayArandomurineprotein:creatininer

4、atiohasbeenshowntocorrelatewitha24-hrestimationExpressedeitherasmg/mg(easy)ormg/mmol(multiplyx0.0088)SpotRatios!24yoladywithankleoedema,proteinuriaandhypercholesterolaemiaSpoturineprotein924mg/LSpoturinecreatinine3343µmol/LRatio=276mg/mmol(normal:0-45)Converttomg/mg(276x0.0088)=2.4g/

5、24hrIdentifyingCKDBISHBASHBOSHStagingofChronicKidneyDiseaseStageDescriptionGFREvaluation/Plan0Atrisk>90Modifyriskfactors1Kidneydamage/>90Diagnose/Treatcause.SlownormalGFRprogressionandevaluateCVrisk.2Mild60-89Estimateprogression3Moderate30-59Evaluateandtreatcomplications4Severe15-29P

6、repareforRRT5ESRD<15InitiateRRTNKF,USAFactorsMediatingEvolutionofCKDSusceptibilityFactorsInitiationFactorsProgressionFactorsSusceptibilityFactorsMalegenderHypertensionAge1ml/yearlossnormallyGeneticBackgroundACEpolymorphismsReducedNephronMassatBirthDiabeticNephropathy>GlomerularDiseas

7、e>TubulointerstitialDisease>HypertensiveNephrosclerosisInitiationFactorsProgressionFactorsProgressivelossofrenalfunctionwilloccurevenintheabsenceofovertactivityoftheprimaryrenaldisorderProgressionFactorsHypertensionGlomerularHypertensionProteinuriaHyperlipidemiaGeneticFactorsMiscella

8、neousExacerb