Yuav Ua Li Cas Ntsuam Xyuas Raum Kev Ua Haujlwm hauv Chaw Kho Mob Sab Nraud

Hu rau: emily.li@wecistanche.com

PE Korhonen^1,2,3

TSEEM CEEB

Keeb kwm

Hauv xyoo 2002, qhov kev txhais tshiab thiab kev faib tawm ntawm cov mob ntevmob raumtau luam tawm, thiab glomerular filtration rate < 60 ml / min / 1.73 m2 rau 3 lub hlis lossis ntau dua tau hloov kho los txhaismob raum mobtsis hais txog lwm yam cim ntawmraum puas. Lub Hom Phiaj: Sib tham txog ntau txoj hauv kev los ntsuaslub raum ua haujlwmnyob rau hauv cov chaw kho mob sab nraud thiab tshwj xeeb tshaj yog nyob rau hauv kev kho mob. Methods: Pub-Med database tau tshawb nrhiav rau cov khoom muaj feem. Cov txiaj ntsig: Qhov kwv yees glomerular filtration rate sib npaug uas suav nrog cov ntshav creatinine, hnub nyoog, poj niam txiv neej, haiv neeg, thiab lub cev loj tau tsim los txheeb xyuas cov neeg mob uas mob ntev.mob raumyav tas los saib tsis taus yog tias lub raum ua haujlwm tau raug soj ntsuam los ntawm plasma creatinine ib leeg. Cystatin C-raws li qhov sib npaug kuj tau tsim los txhim kho qhov tseeb rau cov tib neeg uas muaj creatinine-based kwv yees raulub raum ua haujlwmtau lees paub tias qhov tseeb tsawg dua. Kev Sib Tham: Cov yam ntxwv ntawm cov neeg mob uas qhov kev kuaj mob tau siv tuaj yeem cuam tshuam qhov rhiab heev ntawm qhov kev sim. Yog li, niaj hnub no muaj kev sib cav txog txoj hauv kev zoo tshaj plaws los ntsuaslub raum ua haujlwmnyob rau hauv cov pej xeem. Xaus: Hauv feem coob ntawm cov neeg mob uas tam sim no tau kho hauv kev saib xyuas thawj zaug, CKD-EPI creatinine sib npaug yog tsim nyog rau kev kwv yees lub raum ua haujlwm. CKD-EPIcr-cys kab zauv yuav muab kev ntseeg siab ntxiv rau cov tib neeg uas muaj CKD-EPI creatinine eGFR ntawm 45–59 ml / min / 1.73 m2, tab sis tus nqi ntawm cov tshuaj cystatin C txwv tsis pub nws siv hauv txhua hnub kev coj ua.

Cistanche yog qhov zoo rau lub raum

Taw qhia

Nyob rau hauv 2002, ib tug txhais thiab kev faib ntawmmob raum mobtau qhia los ntawm Tebchaws MeskasLub raumFoundation (K/DOQI) (Table 1) (1). Lub moj khaum no tau muab 'kev txiav txim' tshiab rau cov zej zog kho mob uas tau siv sijhawm ntev los tsis quav ntsej txog qhov mob hnyav.mob raumtshaj li cov kab mob raum kawg, thiab siv cov ntsiab lus tsis zoo xws li lub raum tsis txaus lossis ua ntej uremia. Glomerular filtration rate (GFR) < 60="" ml="" min="" 1.73="" m2="" ntsuas="" ntau="" zaus="" tsawg="" kawg="" 3="" lub="" hlis="" sib="" nrug="" tau="" yoog="" los="" txhais="" cov="" mob="">mob raumtsis hais txog lwm yam cim ntawmraum puas,vim tias nws sawv cev txo qis ntau dua li ib nrab ntawm cov nqi ib txwm muaj ntawm 125 ml / min / 1.73 m2 hauv cov tub ntxhais hluas, thiab qib ntawm GFR no cuam tshuam nrog qhov pib ntawm kev kuaj mob txawv txav yam ntxwv ntawmraum tsis ua haujlwm, suav nrog kev nce ntxiv ntawm ntau yam kev pheej hmoo mob plawv (2). GFR yog sib npaug rau qhov sib npaug ntawm cov txiaj ntsig pom hauv txhua qhov kev ua haujlwm nephrons thiab tuaj yeem suav tias yog qhov ntsuas ntxhib ntawm cov lej ntawm lawv. Cov lus txhais tshiab, zoo ib yam ntawm cov kab mob raum ntev los txhawm rau txheeb xyuas qhov ua ntej, feem ntau asymptomatic theem uas cov kev cuam tshuam tuaj yeem tiv thaiv cov teeb meem ntawmmob raum mobthiab nce mus rau theem kawgmob raum.

Txawm li cas los xij, raws li ib txwm nyob hauv kev kho mob, kev ua tiav ntawm kev kho yog nyob ntawm qhov tseeb ntawm kev kuaj mob. GFR tuaj yeem ntsuas tau ( ntsuas GFR, mGFR) tau meej heev los ntawm kev tshem tawm cov khoom siv exogenous xws li inulin lossis radiopharmaceuticals (125I-iothlamate, 51Cr-EDTA, 99mTc-DTPA), tab sis qhov nyuaj ntawm kev siv thiab kev siv nyiaj tiv thaiv kev siv cov qauv no rau kev kho mob loj heev. Kab lus no tshuaj xyuas cov ntaub ntawv muaj nyob ntawm kev ntsuaslub raum ua haujlwmnyob rau theem ruaj khov. PubMed cov ntaub ntawv tau tshawb nrhiav cov khoom siv uas siv cov ntsiab lus 'creatinine ', 'creatinine clearance', 'cystatin C', 'Cockcroft-Gault', 'glomerular filtration rate', 'MDRD' 'CKD-EPI'. Tsis muaj hnub txwv rau kev tshawb nrhiav. Nees nkaum kab lus raug txheeb xyuas.

Kab lus no tshuaj xyuas cov ntaub ntawv muaj nyob ntawm kev ntsuaslub raum ua haujlwmnyob rau theem ruaj khov. Cov ntaub ntawv PubMed tau tshawb nrhiav cov ntsiab lus uas siv cov ntsiab lus 'creatinine, 'creatinine clearance', 'cystatin C', 'Cockcroft-Gaul', 'glomerular filtration rate', 'MDRD' 'CKD-EPI'. Tsis muaj hnub txwv rau kev tshawb nrhiav. Nees nkaum kab lus raug txheeb xyuas.

Cov ntaub ntawv ntxiv tau raug txheeb xyuas los ntawm cov ntaub ntawv pov thawj thiab cov ntaub ntawv cuam tshuam ntawm cov kab lus xaiv nrog tsom mus rau cov ncauj lus ntsig txog kev kho mob.

Cov tshuaj creatinine

Kev soj ntsuam ntawmlub raum ua haujlwmtau ntau xyoo lawm raws li cov ntshav creatinine concentration, uas yog ib qho pheej yig, ib qho kev sim hauv kev kho mob. Txawm li cas los xij, ntshav ntshav lossis ntshav creatinine yog qhov ntsuas tsis raug rau kev kwv yeeslub raum ua haujlwm: nws pib nce tsuas yog thaum GFR tau ploj zuj zus los ntawm ib nrab, thiab tom qab ntawd qhov nce yog exponential, tsis linear rau GRF deterioration (3). Serum creatinine kuj raug cuam tshuam los ntawm hnub nyoog, poj niam txiv neej, cov leeg nqaij lossis kev puas tsuaj, kev noj zaub mov, haiv neeg, tubular secretion, tshuaj (xws li amiloride, triamterene, spironolactone, trimethoprim), thiab cov txheej txheem kuaj mob (3,4). Hmoov zoo, kev siv cov qauv ntsuas ntsuas rau kev kuaj ntshav creatinine, isotope dilution mass spectrometry (IDMS)-traceable (tus qauv kub) creatinine assays, tau daws qhov sib txawv ntawm qhov sib txawv hauv cov ntshav creatinine (5).

Creatinine tshem tawm

GFR tuaj yeem ntsuas qhov tsis ncaj los ntawm kev ntsuas qhov tshem tawm ntawm creatinine los ntawm cov ntshav nrog rau 24-h cov zis sau.

Txawm li cas los xij, suav nrog creatinine tshem tawm qhia tag nrho cov kev txwv ntawm kev ntsuas creatinine thiab yuav tsum tau sau cov zis kom raug uas cuam tshuam nws txoj kev ntseeg siab hauv kev kho mob niaj hnub.

Serum cystatin C

Cystatin C yog ib qho tsis-glycosylated protein synthesized thiab secreted los ntawm tag nrho cov nucleated hlwb, nws yog freely lim los ntawm lub glomerulus thiab ces reabsorbed thiab catabolized los ntawm lub proximal tubules (6-8). Yog li, GFR yog qhov tseem ceeb ntawm kev txiav txim siab ntawm cystatin C ntshav concentration. Nyob rau hauv sib piv rau creatinine, cystatin C concentration yog tsawg cuam tshuam los ntawm lub hnub nyoog, poj niam txiv neej, nqaij loj, los yog kev noj haus, tab sis tej zaum yuav cuam tshuam los ntawm rog (9), thyroid function (10), haus luam yeeb (11,12), o (11,13). ), steroid therapy (14) thiab viral load hauv HIV (15). Tam sim no muaj cov qauv ntsuas thoob ntiaj teb cov qauv siv rau cystatin C, tab sis tus nqi ntawm kev tshuaj ntsuam yog kwv yees li ob npaug siab dua qhov ntsuas ntshav creatinine concentration.

Qhov sib npaug rau kwv yees glomerular filtration rate

Muaj ntau txoj hauv kev tau ua kom kov yeej qhov teeb meem ntawm kev ntsuas creatinine hauv kev ntsuaslub raum ua haujlwm.Qhov kwv yees glomerular filtration rate (eGFR) sib npaug siv hnub nyoog, poj niam txiv neej, haiv neeg, thiab lub cev loj li surrogates rau endogenous creatinine tiam thiab excretion. Txawm li cas los xij, cov qauv no tseem ua raws li cov ntshav creatinine thiab tsis tuaj yeem pom qhov sib txawv hauv creatinine ntau lawm, tubular secretion, lossis kev tshem tawm ntawm cov neeg. Ua raws li cov kev ua yuam kev no rau hauv tus account, ib qho eGFR nyob rau hauv 30 feem pua ​​​​ntawm mGFR yog xam tau los ntawm K/DOQI rau kev kho mob txhais lus los txheeb xyuas cov neeg uas muajmob raum mob (1)

Cockcroft-Gault equation

Cockcroft thiab Gault tau tsim ib qho kev sib npaug rau kev kwv yees GFR los ntawm ib pawg me me ntawm cov neeg mob hauv tsev kho mob hauv xyoo 1976 (16). Qhov sib npaug yog lej yooj yim:

Qhov kev sib npaug no muaj cov kev txwv tseem ceeb: cov ntaub ntawv kev loj hlob tau suav nrog cov neeg dawb xwb (4 feem pua ​​​​cov poj niam), txoj kev siv yog creatinine tshem tawm (tsis yog GFR), thiab qhov hnyav covariate yog qhov ua yuam kev hauv cov neeg rog rog lossis cov neeg mob uas muaj lub cev tsis muaj zog. loj index.

Kev Hloov Kho Kev Noj Qab Haus Huv hauv Kev Sib Txuas Kab Mob Raum

Xyoo 1999, Levey et al. qhia txog qhov kev sib npaug eGFR tshiab raws li GFR qhov tseem ceeb ntsuas los ntawm iothalamate clearance (17). Cov mis tsis tas yuav muaj qhov sib txawv ntawm qhov hnyav vim nws normalizes GFR rau tus qauv ntawm lub cev thaj tsam ntawm 1.73 m2. Qhov sib npaug tau tsim los ntawm cov ntaub ntawv ntawm Kev Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob (MDRD) Txoj Kev Kawm uas muaj cov ncauj lus nrog ntau yam tsis muaj ntshav qab zibkab mob raum(txhais tau tias GFR 40 ml / min / 1.73 m2) (17). Qhov yooj yim ntawm plaub-txheej txheem MDRD Txoj kev sib npaug rau kev siv nrog IDMS traceable (tus qauv kub) ntshav creatinine assay (18) yog tam sim no qhov feem ntau siv sib npaug rau eGFR:

eGFR(ML/MIN/1.73m²

=175 x (serum creatinine/88.4) ^-1.154

x (hnub nyoog) {{0}}.203 x (0.742 yog poj niam)

x (1.212 yog rov qab)

Hauv kev soj ntsuam meta-tshaj tawm tsis ntev los no ntawm cov pej xeem hauv zej zog, qhov kev pheej hmoo ntawm tag nrho cov neeg tuag tau dhau los ua qhov tseem ceeb nyob ib puag ncig eGFR 60 ml / min / 1.73 m2 thiab yog ob zaug siab dua nyob ib puag ncig eGFR 30–45 ml / min / 1.73 m2 piv nrog qhov zoo tshaj eGFR qib 90– 104 ml / min / 1.73 m2 xam nrog MDRD formula (19).

Thaum qhov kev tshaj tawm ntawm eGFR siv MDRD Kev Tshawb Fawb Kev Ua Haujlwm tau pib pib hauv UK, tus naj npawb ntawm kev xa mus los ntawm kev saib xyuas thawj zaug rau nephrologist tau nce 2.7-fold (20). Qhov no qhia txog qhov nce ntxiv ntawm cov neeg mob uas tsis tau xav tias muaj mob ntevmob raumraws li kev ntsuas creatinine yooj yim tab sis kuj tau ua rau muaj kev txhawj xeeb txog kev kuaj mob ntau dhaumob raum mobnyob rau hauv cov pej xeem (21). Qhov tseeb, MDRD Kev Tshawb Fawb Kev Sib Txuas tau pom tias muaj qhov tsis txaus ntseeg qhov tseeb GFR hauv cov ncauj lus uas ntsuas GFR Ntau dua lossis sib npaug li 60 ml / min / 1.73 m2 (22–25).

Mob raum kab mob creatinine sib npaug

CovMob raum mobEpidemiology Collaboration (CKD-EPI) tau tsim ib qho kev sib npaug eGFR tshiab los muab kev kwv yees tseeb dua ntawm GFR ntawm cov tib neeg uas muaj qhov qub lossis me me GFR (26).

Qhov sib npaug CKD-EPI tau muab los ntawm cov kev tshawb fawb suav nrog 5504 yam uas muaj lossis tsis muajmob raum mob, uas muaj ntau yam GFRs (txhais tau tias GFR 67 ml / min / 1.73 m2) ntsuas los ntawm iothalamate clearance (27). Hauv CKD-EPI kab zauv, sib txawv exponents yog siv rau cov ntshav creatinine raws li qib creatinine thiab poj niam txiv neej:

eGFR (ml/min/1.73m²)

=141 x min (serum creatinine/k,1)

x max (serum creatinine / k, 1)^-1.209

x 0.993 ^{hnub nyoog}x 1.018 (yog poj niam) x 1.159 (yog tias rov qab)

min qhia qhov tsawg kawg nkaus ntawm cov ntshav creatinine / k lossis 1, thiab max qhia qhov siab tshaj plaws ntawm cov ntshav creatinine / k lossis 1.
k {{0}}.7 rau poj niam, 0.9 rau txiv neej

ib -0.329 rau poj niam, -0.411 rau txiv neej

Qhov sib npaug CKD-EPI tau pom tias ua tau zoo dua ntawm MDRD Txoj Kev Sib Tw, tshwj xeeb tshaj yog rau cov tib neeg uas muaj GFR ntau dua 60 ml / min / 1.73 m²; qhov nruab nrab qhov sib txawv ntawm kev kwv yees thiab ntsuas GFR (ib qho kev ntsuas ntawm kev tsis ncaj ncees) yog -10.6 ml/min/1.73 m² rau MDRD Kev Kawm Equation thiab -3.5 ml/min/1.73 m²rau CKD-EPI kab zauv (26).

Peb pawg neeg coob coob uas tsis ntev los no tau muab piv rau CKD-EPI thiab MDRD qhov sib npaug. Hauv Teb Chaws Asmeskas cov neeg laus hnub nyoog Ntau dua lossis sib npaug li 20 xyoo, qhov tshwm sim ntawmmob raum mobyog 11.6 feem pua ​​​​yog siv qhov sib npaug CKD-EPI thiab 13.1 feem pua ​​​​ntawm MDRD kab zauv (26). Cov ntaub ntawv sib thooj hauv cov pej xeem Australian neeg laus yog 11.5 feem pua ​​thiab 13.4 feem pua ​​(28). Qhov nthuav dav ntawmmob raum mobtheem 3 (eGFR 30–59 ml / min / 1.73 m2) tau txo los ntawm 2.5 feem pua ​​​​ntawm cov mis MDRD mus rau 1.4 feem pua ​​​​thaum cov mis CKD-EPI tau siv rau hauv ib pawg ntawm cov neeg Asmeskas hnub nyoog 45–64 xyoo (29). Qhov tseem ceeb, cov neeg koom ntawm ob qhov kev tshawb fawb dhau los uas tau muab cais tawm los ntawm eGFR 30–59 ml / l / 1.73 m2 raws li MDRD formula rau eGFR 60–89 ml / min / 1.73 m2 siv CKD-EPI formula, muaj Kev pheej hmoo tsawg dua ntawm txhua qhov ua rau tuag, cov xwm txheej tseem ceeb ntawm cov hlab plawv, thiab cov kab mob hauv lub raum kawg piv nrog cov uas tsis tau muab cais tawm (28,29).

CKD-EPI cystatin C thiab CKD-EPI creatinine-cystatin C sib npaug

Tsis ntev los no, lub koom haum CKD-EPI tau tshaj tawm ob qhov sib npaug tshiab rau kev kwv yees GFR; ib qho siv cov ntshav cystatin C (CKD-EPIcys) thiab lwm qhov siv cov ntshav creatinine thiab ntshav cystatin C (CKD-EPIcrcys) (30). Qhov sib npaug ntawm CKD-EPI cystatin C:

133 x min (serum cystatin C/0.8,1)^-0.499

x max (serum cystatin C/0.8,1)^-1.328 x 0.996^{hnub nyoog}

x 0.932 (yog poj niam)

min qhia qhov tsawg kawg nkaus ntawm cov ntshav cystatin C/k lossis 1, thiab max qhia qhov siab tshaj plaws ntawm cov ntshav cystatin C/k lossis 1. Qhov sib npaug ntawm CKD-EPI creatinine-cystatin C:

135 x min (serum creatinine / k, 1)

x max (serum creatinine / k, 1)^-0.601

x min (serum cystatin C/0.8,1)^-0.375

x max (serum cystatin C/0.8,1)^-0.711 x 0.995^{hnub nyoog}

x 0.969 (yog tsev neeg) x 1.08 (yog tias rov qab)

k yog {{0}}.7 rau poj niam thiab 0.9 rau txiv neej

yog -0.248 rau poj niam thiab -0.207 rau cov txiv neej min qhia qhov tsawg kawg nkaus ntawm cov ntshav creatinine/k lossis 1, thiab max qhia qhov siab tshaj plaws ntawm cov ntshav creatinine/k lossis 1

Cov ntaub ntawv los ntawm 13 pawg neeg ntawm ntau haiv neeg tau siv los txhim kho cov kev sib npaug no, thiab GFR kev ntsuas tau ua raws li cov zis los yog ntshav tshem tawm ntawm exogenous filtration markers. CKD-EPIcys kab zauv ua tau zoo ib yam li CKD-EPI creatinine kab zauv nyob rau hauv ntau pawg ntawm cov neeg mob, suav nrog cov uas tsis muaj lub cev qhov hnyav. Qhov zoo siab, qhov sib npaug CKD-EPcr-cys ua tau zoo dua li qhov sib npaug uas siv creatinine lossis cystatin C ib leeg. Hauv cov neeg koom nrog uas nws eGFR raws li CKD-EPI creatinine yog 45–59 ml / min / 1.73 m2, CKD-EPIcr-cys kev sib npaug raug muab faib ua 17 feem pua ​​​​ntawm lawv muaj GFR Ntau dua lossis sib npaug li 60 ml / min / 1.73 m2 ( 30).

Hauv kev tshuaj ntsuam meta-11 cov kev tshawb fawb pej xeem, qhov tshwm sim ntawm eGFR < 60="" ml="" min="" 1.73="" m2="" yog="" 9.7="" feem="" pua="" ​​​​ntawm="" ckd-epi="" creatinine="" sib="" npaug,="" 13.7="" feem="" pua="" ​​​​ntawm="" ckd-epicys="" sib="" npaug,="" thiab="" 10.0="" feem="" pua="" ​​nrog="" ckd-cys="" equation="" (31).="" qhov="" kev="" tshuaj="" ntsuam="" meta="" kuj="" suav="" nrog="">mob raum mobpawg nrog 2960 tus neeg koom. cystatin C-raws li kev suav ntawm eGFR rov faib 42 feem pua ​​​​ntawm cov neeg koom nrog kev kawm nrog creatinine-based eGFR ntawm 45–59 ml / min / 1.73 m2 txog> 60 ml / min / 1.73 m2. Tsis tas li ntawd, cov kev hloov pauv tshiab tau txo qis ntawm 34 feem pua ​​​​ntawm kev pheej hmoo ntawm kev tuag los ntawm ib qho laj thawj, piv rau cov neeg uas eGFR tsis tau muab cais tawm (31). Qhov kev pheej hmoo ntawm kev tuag los ntawm ib qho laj thawj thiab los ntawm cov kab mob plawv tau nce ntxiv rau txhua qib eGFR thaum qhov txiaj ntsig rau CKD-EPIcys thiab CKD-EPIcr-cys qis dua qhov pib ntawm 85 ml / min / 1.73 m2 (31). Yog li, eGFR qhov sib npaug raws li kev ntsuas ntawm cystatin C tuaj yeem siv los txheeb xyuas qhov kev pheej hmoo ntau ntxiv ntawm cov txiaj ntsig tsis zoo uas tsis tau kuaj pom nrog tsuas yog creatinine-raws li kev suav ntawm eGFR.

CovKab mob raumKev Txhim Kho Ntiaj Teb Kev Ua Tau Zoo (KDIGO) 2012 Cov Lus Qhia Txog Kev Kho Mob pom zoo kom ntsuas cov ntshav cystatin C thiab kwv yees ntawm GFR los ntawm cov lus nug ua ke CKD-EPIcr-cys rau cov neeg laus uas eGFR raws li cov ntshav creatinine nyob hauv thaj tsam ntawm 45–59 ml / min. /1.73 m2, tab sis leej twg tsis muaj cov cim ntawmraum puas (32).

Hauv kev tshawb fawb ntawm cov neeg European poj koob yawm txwv hnub nyoog 74 xyoo thiab laus dua, peb qhov sib npaug CKD-EPI tau tshwm sim ntau dua li qhov kev sib npaug ntawm MDRD, tab sis qhov txawv tsuas yog rau cov tib neeg uas muaj eGFR Ntau dua lossis sib npaug li 60 ml / min / 1.73 m2 (33). Yog li, MDRD Txoj Kev Sib Tw ua tau zoo heev hauv kev kho mob ntawm cov neeg laus, uas nws cov leeg nqaij, noj cov protein kom tsawg, thiab GFR zoo dua rau cov kab mob kev loj hlob ntawm MDRD Study (33). Ntxiv mus, cov nyhuv ntawm kev laus ntawm cystatin C qib muaj zog, tshwj xeeb tshaj yog nyob rau hauv cov txiv neej (34).

Cov ntsiab lus

Cov yam ntxwv ntawm cov neeg mob uas qhov kev kuaj mob tau siv thiab theem lossis qhov hnyav ntawm tus kab mob (Table 2) tuaj yeem cuam tshuam qhov rhiab heev ntawm qhov kev sim (35). Hauv feem coob ntawm cov neeg mob tam sim no tau kho hauv kev saib xyuas thawj zaug, CKD-EPI creatinine sib npaug yog tsim nyog rau kev kwv yees lub raum ua haujlwm. CKD-EPIcr-cys kab zauv yuav muab kev ntseeg siab ntxiv rau cov tib neeg uas muaj CKD-EPI creatinine eGFR ntawm 45–59 ml / min / 1.73 m2 (31), tab sis tus nqi ntawm cov tshuaj cystatin C thiab qhov tseeb ntawm cov neeg laus tseem txwv. nws siv nyob rau hauv txhua txhua hnub kev xyaum.

Tus neeg mob tau piav qhia hauv vignette muaj eGFR ntawm 58 thiab 62 ml / min / 1.73 m2 raws li MDRD Txoj Kev Kawm thiab CKD-EPIcreatinine sib npaug, raws li. Vim nws rog dhau, Cockcroft-Gault mis raug suav tias yog kev tsis ncaj ncees. Serum cystatin C tsis tau ntsuas thiab yog li, CKD-EPIcys thiab CKD-EPIcr-cys sib npaug tsis tuaj yeem siv.

Txawm hais tias tus neeg mob tsis muaj albuminuria lossis lwm yam tsos mobraum puas, nws raug kuaj nrogmob raum mobraws li MDRD Study Equation. Qhov no tuaj yeem ua rau nws tus kws kho mob txo qis cov tshuaj ACE inhibitor thiab metformin. Txawm li cas los xij, kev kuaj mob raum mob ntev yuav tsum muaj ob qhov kev ntsuas eGFR tsawg kawg 3 lub hlis sib nrug (32). Nws yuav tsum tau hais tias kev ua raws li cov kev cailub raum ua haujlwmyog ib qho tseem ceeb heev hauv kev txiav txim siab kho mob. Yog tias peb tus neeg mob yuav muaj lub raum ua haujlwm ruaj khov thaum taug qab, nws tsuas yog yuav raug kev txom nyem los ntawm kev kub siab, ntshav qab zib, thiab dyslipidemia ntau xyoo nrog rau ischemia thiab lub raum tsis ua haujlwm. Nyob rau hauv tas li ntawd, nws yuav tau txais txiaj ntsig ntxiv los ntawm cov tshuaj tiv thaiv lub plawv thiab lub raum xws li ACE inhibitors thiab metformin. KDIGO cov lus qhia qhia txog kev mob raum mob ntev raws li qhov poob qis hauv eGFR qeb (Table 1) nrog rau ntau dua lossis sib npaug li 25 feem pua ​​​​poob hauv eGFR los ntawm lub hauv paus, lossis kev poob qis hauv eGFR> 5 ml / min / 1.73 m2 ib xyoos twg (33).

Txawm li cas los xij, peb tus neeg mob tsawg kawg yog me ntsis txo qislub raum ua haujlwmmuaj kev pheej hmoo mob mob los yogmob raum raug mobthaum lub sij hawm ntawm physiological kev nyuaj siab. Yog li ntawd, nws raug pom zoo tias cov tshuaj uas muaj peev xwm nephrotoxic thiab tso tawm tiag tiag (ACE inhibitors, angiotensin-receptor blockers, aldosterone inhibitors, renin inhibitors, diuretics, NSAIDs, metformin, lithium, digoxin) yuav tsum txiav tawm yam tsawg kawg ib ntus thaum mob hnyav, piv txwv li, mob hnyav, ntuav, raws plab lossis phais (33).

Kev tswj ntshav siab yog qhov tseem ceeb hauv kev tiv thaiv ntawmmob raum mobkev vam meej. KDIGO 2012 Clinical Practice Guideline (33), European Society of Hypertension thiab European Society of Cardiology 2013 Guidelines for the management of arterial hypertension (36), and the Eighth Joint National Committee (JNC 8) Guideline 2014 (37) pom zoo tias nyob rau hauv cov neeg mob nrogmob raum mobthiab tsis muaj albuminuria, lub hom phiaj ntshav siab yuav tsum yog <140 0="" mmhg="" thiab="" kev="" xaiv="" tshuaj="" thawj="" zaug="" yuav="" yog="" ace="" inhibitor="" lossis="" angiotensin-receptor="" blocker.="" yog="" li,="" tus="" neeg="" mob="" tau="" piav="" qhia="" hauv="" vignette="" yuav="" tsum="" ua="" kom="" nws="" cov="" ntshav="" siab="" qis="" kom="" ua="" tiav="" qib="">

2014 John Wiley & Sons Ltd

Int J Clin Pract, Lub Ob Hlis 2015, 69, 2, 156–161. DOI: 10.1111/ijcp.12516

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