Dab tsi yog Qhov Tseem Ceeb Ntawm 2023 KDIGO CKD Cov Lus Qhia Txog Kev Ntsuas Thiab Kev Ntsuas?

Kab mob raum: Txhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) yog lub koom haum tsis muaj txiaj ntsig tau mob siab rau kev txhim kho kev saib xyuas thiab txiaj ntsig rau cov neeg mob raum thoob ntiaj teb. Nws cov lus qhia yog cov ntaub ntawv tseem ceeb rau cov kws kho mob nephrologist thiab kws saib xyuas neeg mob hauv ntau lub tebchaws thiab cheeb tsam.

Nyem rau cistanche tubulosa extract rau mob raum

Thaum Lub Rau Hli 16, 2023, ntawm 60th European Renal Association Congress (ERA), cov kws tshaj lij los ntawm KDIGO tau tshaj tawm cov xov xwm yuav los tom ntej thiab qee cov ntsiab lus tseem ceeb ntawm 2023 KDIGO Kab Mob Raum Kab Mob (CKD) Cov Lus Qhia.

2023 KDIGO CKD Cov Lus Qhia ua rau ntau qhov kev hloov pauv tseem ceeb rau kev kuaj mob thiab kev ntsuam xyuas kab mob raum (CKD). Cov kev hloov pauv no suav nrog kev txhais thiab kev faib tawm ntawm CKD, kev kuaj mob thiab kev soj ntsuam cov qauv, kev kuaj xyuas qhov taw qhia (POCT), kwv yees glomerular filtration rate (eGFR), thiab kev twv twv yuav raug mob. Cov txheej txheem kho tshiab no yuav muab cov kws kho mob paub txog qhov tseeb thiab nthuav dav rau kev kuaj mob thiab kev ntsuas ntawm CKD, pab txhim kho kev saib xyuas thiab kev tswj xyuas tus neeg mob.

· Xyaum taw tes 1: CKD yuav tsum sib txawv ntawm lub raum raug mob (AKI). Qee cov neeg mob AKI muaj cov tsos mob zoo sib xws rau CKD; Yog tias tus neeg mob raug txiav txim siab tias muaj kev pheej hmoo siab ntawm kev mob raum lossis tuaj yeem tsim CKD, kev kho CKD tuaj yeem ua tiav thaum kuaj thawj zaug.

Lub hom phiaj ntawm qhov kev coj ua no yog tias, rau cov neeg mob uas muaj kev pheej hmoo CKD lossis muaj kev pheej hmoo siab rau CKD, kev kuaj mob qeeb yuav ncua kev kho mob. Yog tias tsis tau pib kho, ntau tus neeg mob yuav tsis paub qhov tseem ceeb ntawm kev mus ntsib. Kev pib kho mob tso cai rau kev cuam tshuam ntxov, qhia rau tus neeg mob txog qhov tseem ceeb ntawm tus kab mob los ntawm kev ua.

Kev ntsuam xyuas Etiological ntawm CKD

Kev pom zoo 1: Txhua tus neeg mob uas muaj CKD yuav tsum raug soj ntsuam rau etiology, suav nrog kev soj ntsuam keeb kwm yav dhau los, tus kheej thiab tsev neeg keeb kwm, kev sib raug zoo thiab ib puag ncig, kev kho tshuaj, tshuaj xyuas lub cev, kev sim kuaj, kuaj pom, thiab kuaj kab mob pathological (1D).

Kev pom zoo 2: Lub raum biopsy yog ib qho kev kuaj pom muaj kev nyab xeeb thaum tsim nyog thiab yuav tsum tau ua raws li cov txheej txheem los txo cov teeb meem (2D).

Kev ntsuam xyuas Point of Care (POCT)

Nws tau pom zoo tias POCT tuaj yeem siv los kuaj xyuas cov ntshav creatinine thiab proteinuria, tshwj xeeb tshaj yog rau kev siv cov chaw kuaj mob lossis cov peev txheej kho mob tsawg. Nyob rau tib lub sijhawm, POCT muaj ob qhov txiaj ntsig tshwj xeeb, uas yog, qhov zoo ntawm kev noj qab haus huv kev lag luam thiab muaj peev xwm ua tau raws li cov kev xav tau ntawm kev kho mob tshwj xeeb.

Xyaum taw tes 1: Thaum POCT cov cuab yeej saib xyuas cov zis albumin-to-creatinine ratio (UACR), nws cov qauv sau thiab kev soj ntsuam yuav tsum ua raws li cov qauv zoo. Tsis tas li ntawd, kev ntsuam xyuas zoo yuav tsum suav nrog kev ntsuam xyuas sab nraud thiab kev txhais cov txiaj ntsig.

Tswv yim 2: Thaum siv POCT ntaus ntawv uas tuaj yeem ntsuas creatinine, nws yuav tsum tsim eGFR siv cov qauv eGFR zoo ib yam li siv hauv qhov chaw / cheeb tsam.

Tswv yim 3: Thaum POCT ntaus ntawv yog siv los ntes albuminuria, nws yuav tsum tau soj ntsuam creatinine thiab tsim UACR. Thaum cov neeg mob albuminuric tau txais POCT albuminuria kuaj, tus nqi zoo yuav tsum siab dua 95 feem pua.

Ntau qhov kev tshawb fawb tau ua pov thawj pom tau qhov tseeb ntawm POCT rau kev ntsuas creatinine lossis eGFR hauv cov neeg mob uas tau txais kev sib piv-txhim kho CT scans thiab muaj eGFR.<30 ml/min/1.73 m2. At the same time, other studies have confirmed that POCT can reduce medical expenses.

Zuag qhia tag nrho, point-of-care testing (POCT) muaj ntau yam zoo hauv kev tswj cov kab mob raum ntev (CKD). Ua ntej, nws yog qhov yooj yim rau cov neeg mob saib xyuas hauv tsev, lossis mus ntsib lub tsev kho mob uas tsis yog nruab nrab / loj kom tsis txhob muaj kev pheej hmoo ntawm tsev kho mob / tsev kho mob hla kev kis kab mob thiab txo qhov kev xav tau kev mus ncig. Qhov thib ob, POCT yog qhov yooj yim rau kev khiav lag luam (piv rau kev sau cov ntshav venous). Tsis tas li ntawd, cov qauv siv hauv POCT yog tag nrho cov ntshav / zis, uas zam cov txheej txheem cumbersome ntawm cov qauv hloov pauv thiab ua tiav. Tsis tas li ntawd, txij li cov qauv ntawm POCT feem ntau yog cov ntshav ntiv tes, nws yuav siv tau ntau dua rau cov neeg mob menyuam yaus. Hauv cov ntsiab lus, POCT muaj ntau yam zoo hauv kev tswj hwm ntawm CKD, uas tuaj yeem txhim kho kev yooj yim ntawm cov neeg mob thiab kev kho mob zoo.

Raws li cov lus pom zoo sib txawv, cov ntsiab lus no tau muab faib ua cov lus pom zoo thiab cov ntsiab lus kho mob rau cov kws kho mob thiab cov chaw kuaj mob.

01 Rau Cov Kws Kho Mob

Cov ntsiab lus tswv yim 1: Txhawb cov kws kho mob kom nkag siab meej txog kev sib raug zoo ntawm ib lossis ob lub biomarkers (creatinine thiab cystatin C) thiab eGFR, qhia meej txog lawv cov nqi thiab cov kev txwv, nkag siab qhov tseem ceeb ntawm kev tsim qauv ntawm ob txoj kev tshawb nrhiav, thiab nkag siab thaum kev ntsuam xyuas raug ntau dua. glomerular filtration rate (GFR) yog xav tau.

Tswv yim 2: Txhawb cov kws kho mob kom nkag siab txog txoj hauv kev zoo tshaj los ntsuas GFR (mGFR) thiab yuav ua li cas txo qhov yuam kev; Yog tias qhov tseeb mGFR tsis muaj thiab eGFR cys (raws li cystatin C) raug suav tias yog qhov tsis raug, sijhawm sau cov zis yuav raug txiav txim siab.

Tsis tas li ntawd, KDIGO txhawb cov kws kho mob kom nkag siab txog kev paub txog kev lom neeg thiab kev sim tshuaj ntsuam xyuas qhov sib txawv ntawm creatinine thiab cystatin C; Cov kws kho mob raug txhawb kom nkag siab txog qhov tsis raug thiab ua rau eGFR, thiab cov laj thawj ntawm qhov sib txawv ntawm eGFR cr (raws li creatinine) thiab eGFR cys.

Nws tsim nyog sau cia tias cov kws kho mob lossis cov kws saib xyuas neeg mob yuav tsum ceeb toom cov neeg mob kom tsis txhob noj cov protein ntau, xws li noj nqaij lossis ntses ntau dhau, 12 teev ua ntej tau txais kev kuaj cystatin C lossis creatinine. Thaum txhais cov txiaj ntsig eGFR, qhov ua rau eGFR yuav tsum tau txiav txim siab thiab sib txuas lus rau tus neeg mob.

02 Rau cov chaw kuaj mob

Cov lus pom zoo 1: Thaum qhia txog cov ntshav qab zib ntau ntawm GFR-hais txog biomarkers, eGFR qib yuav tsum tau tshaj tawm siv cov qauv siv tau;

Kev pom zoo 2: Yog eGFR<60ml/min/1.73㎡, it should be marked as "low level";

Kev Pom Zoo 3: Rau kev kuaj ntshav creatinine, tag nrho cov ntshav kuaj yuav tsum tau ua tiav hauv 12 teev tom qab venipuncture (ntxiv ntshav / ntshav sib cais);

Kev pom zoo 4: Siv cov txheej txheem tshwj xeeb thiab raug los ntsuas qhov concentration ntawm GFR-hais txog biomarkers, uas tuaj yeem muab piv nrog cov qauv siv thoob ntiaj teb, thiab sim txo qhov sib txawv (1B);

· Cov lus pom zoo 5: Cov qib creatinine yuav tsum tau ntsuas los ntawm txoj kev enzymatic.

Tswv yim 1: Thaum ntsuas cystatin C, cov ntshav creatinine qib yuav tsum tau ntsuas tib lub sijhawm hauv cov neeg mob hauv tib lub xeev nyob rau tib hnub lossis nyob rau lub sijhawm tsim nyog, kom eGFR cr thiab eGFR cys tuaj yeem sib piv (kev nyeem ntawv: Kev ntsuam xyuas Creatinine thiab cystatin C Tej zaum yuav muaj qhov sib txawv tseem ceeb hauv GFR ntawm cov neeg mob, thiab nws muaj feem cuam tshuam nrog lub plawv tsis ua haujlwm);

Cov ntsiab lus tswv yim 2: Yog tias muaj cov peev txheej txaus, cov chaw kuaj mob yuav tsum tso cai rau eGFR cr thiab eGFR cys ua qhov ntsuas rau kev kuaj sab hauv lossis xa mus kuaj;

Practice point 3: When the patient is a child, the eGFR formula for children should be used; if the child is >2 xyoos thiab eGFR yog<60ml/min/1.73㎡, "decrease" should be marked.

Kev kwv yees kev pheej hmoo

2023 KDIGO CKD cov lus qhia tau hloov pauv tseem ceeb hauv kev pheej hmoo ntawm kev kis tus kab mob hauv cov neeg mob CKD. Cov lus qhia tshiab taw qhia tias nws yog qhov nyuaj rau kev kwv yees qhov tseeb ntawm txhua qhov kev tshwm sim tsis zoo tsuas yog los ntawm eGFR thiab / lossis ACR ntsuas. Yog li ntawd, yam xws li tus neeg mob tus yam ntxwv ntawm pej xeem, comorbidities, thiab txoj kev ua neej yuav tsum tau txiav txim siab tag nrho thaum ua raws li kev kwv yees. Qhov tseem ceeb tshaj, cov qauv kev kwv yees qhov tseeb yuav tsum tau siv rau kev ntsuas kev pheej hmoo ntawm tus kheej ntawm cov neeg mob, uas yog lub hauv paus rau kev kho tus kheej. Los ntawm kev kwv yees qhov kev pheej hmoo raug raug, cov kws kho mob tuaj yeem nkag siab zoo dua txog kev kis tus kab mob ntawm cov neeg mob thiab tsim cov phiaj xwm kho mob ntau dua, yog li txhim kho kev tswj hwm thiab kho cov txiaj ntsig ntawm cov neeg mob CKD.

Nws tau tshaj tawm tias KDIGO cov lus qhia no tau hloov kho "Heat Map" ntsig txog CKD staging, thiab yuav tsis siv xyoo 2012 lawm. Daim duab hauv qab no yog daim ntawv qhia kev pheej hmoo ntawm kev faib tawm / "kho daim ntawv qhia" rau cov neeg mob CKD pom zoo los ntawm cov lus qhia no. Txawm li cas los xij, cov ntsiab lus tshwj xeeb ntawm CKD theem hauv daim duab no yuav tsum tau tos rau kev tshaj tawm ntawm 2023 KDIGO CKD cov lus qhia.

· Xyaum taw tes 1: Ntxiv nrog rau eGFR, urinary ACR, thiab lwm yam kev kho mob, kev xa mus rau nephrology yuav tsum tau ua raws li seb qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm li ntawm 5 xyoos yog ntau dua lossis sib npaug rau 3-5 feem pua.

· Xyaum taw tes 2: Ntxiv nrog rau eGFR, urinary ACR, thiab lwm yam kev kho mob yam ntxwv, lub sij hawm ntawm kev kho ntau yam kev qhuab qhia yuav tsum tau txiav txim raws li seb tus neeg mob lub 10- xyoo lub raum tsis ua hauj lwm yuav muaj ntau tshaj los yog sib npaug rau 10 feem pua.

· Xyaum taw tes 3: Ntxiv nrog rau eGFR, urinary ACR, thiab lwm yam kev kho mob cov yam ntxwv, lub sij hawm ntawm vascular nkag yuav tsum tau txiav txim raws li seb tus neeg mob qhov kev pheej hmoo ntawm lub raum tsis ua hauj lwm nyob rau hauv 2 xyoo yog ntau tshaj los yog sib npaug rau 40 feem pua.

· Xyaum taw tes 4: Rau kev kwv yees txog kev pheej hmoo tuag rau cov neeg mob CKD, tag nrho cov-ua rau tuag taus kev kwv yees tus qauv tsim nyob rau hauv cov pej xeem CKD yuav tsum tau siv.

Cov ntsiab lus saum toj no yog lub ntsis ntawm cov dej khov ntawm phau ntawv qhia no, thov tos rau qhov kev tso tawm ntawm 2023 KDIGO CKD phau ntawv qhia kom paub ntau ntxiv. Nws tau tshaj tawm tias cov lus qhia no yuav raug tso tawm hauv ob peb lub lis piam tom ntej no. Thov ua tib zoo mloog mus rau Yimaitong raum channel kom paub txog cov kev hloov tshiab hauv cov lus qhia no!

Cov ntaub ntawv:

1. Rumeyza Kazancioglu. KDIGO 2023 CKD GL: Kev Ntsuas ntawm CKD: Dab tsi hloov? ERA 2023. Lub Rau Hli 16, 2023.