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成人慢性肾脏病的定义和分期

Authors
Andrew S Levey, MD
Lesley A Inker, MD, MS
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
John P Forman, MD, MSc
Translators
杨俊伟, 主任医师，教授

引言

美国国家肾脏病基金会(National Kidney Foundation, NKF)的肾脏病预后质量倡议(Kidney Disease Outcomes Quality Initiative, KDOQI)于2002年制定了慢性肾脏病(chronic kidney disease, CKD)的定义和分期指南，国际指南小组改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes, KDIGO)于2004年采纳了该指南并进行了小幅修改[1-3]。

人们曾经将肾脏病视为一种危及生命的少见疾病，需由肾脏专科医师治疗。而CKD指南将人们对肾病的这一观念转变为了肾脏病是一种严重程度不一的常见疾病，可由普通内科医师诊治，并需要有关预防、早期检测和治疗的策略[4,5]。指南对临床实践、研究及公共卫生产生了巨大的影响，但也引起了很大争议[6-11]。

本文将会介绍最新的CKD定义和分期。肾功能评估、CKD的流行病学、CKD的筛查、CKD患者的评估、CKD治疗概述及CKD与心血管疾病的关联将在别处讨论。 (参见“肾功能的评估”和“慢性肾脏病的流行病学”和“慢性肾病的筛查”和“急性肾损伤(急性肾衰竭)或慢性肾脏病患者的诊断方法”和“儿童慢性肾脏病的管理概述”和“慢性肾脏病和冠状动脉性心脏病”)

新指南解决的争议

2009年，KDIGO召开了一次争议会议，以求解决争议的关键问题并回顾150多万例患者的数据(来自45项队列研究，由CKD预后联盟收集)[12-16]。会议讨论了以下争议：

  • 用于界定CKD的白蛋白尿阈值是否应仍为30mg/d(或等价标准)？
  • 用于界定CKD的肾小球滤过率(glomerular filtration rate, GFR)阈值是否应仍为60mL/(min·1.73m2)？
  • 用于界定CKD的GFR是否应取决于年龄？
  • CKD患者的分期除了根据GFR之外是否还应根据白蛋白尿？

                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-16.
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