慢性病:预防,诊断和治疗
Andrew J Goodbred1, Robert C Langan2
1St. Luke's Family Medicine Residency-Anderson, Easton, Pennsylvania; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
American family physician
|January 12, 2024
概括
慢性病 (CKD) 查对于风险人群的早期检测至关重要. 管理涉及血压控制,特定药物,并避免在晚期阶段的对比介质,以减少进展到末期病.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内部医学 内部医学
- 公共卫生 公共卫生
背景情况:
- 慢性病 (CKD) 影响美国15%的人口,往往未被诊断出来.
- 建议对患有心血管疾病,糖尿病,高血压,年龄较大,家族病史,先前急性损伤或孕前的人进行查.
研究的目的:
- 概述慢性病 (CKD) 的当前查,诊断和管理策略.
- 强调精确估计膜过率 (eGFR) 计算和对CKD进展的风险评估的重要性.
主要方法:
- 诊断和分期依赖于eGFR (使用CKD-EPI肌素方程没有种族),尿路白蛋白分泌和损伤证据.
- 建议在CKD患者中进行血清囊素C测量以确认eGFR.
- 血压管理目标<140/90毫米升,耐受性患者的血压目标≤120毫米升,使用ACE抑制剂或ARBs.
主要成果:
- 没有种族的CKD-EPI肌素方程是计算eGFR的首选方法.
- 建议使用 ангиотензин转化酶抑制剂或 ангиотензин受体抑制剂来控制血压.
- -葡萄糖共传输体-2 抑制剂和甲福林被考虑用于糖尿病CKD患者的血糖控制.
结论:
- 跨学科的管理对于降低CKD发病率和死亡率至关重要.
- 患有慢性病进展高风险的患者应转诊至科医生.
- 建议在晚期的CKD中避免静脉注射含的对比剂,以防止eGFR降低.
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