[在一般实践中对高风险患者进行前性CKD查]
Jürgen Flohr1, Sandra Kemerle2, Sebastian Klein3
1Leipzig und Leipziger Gesundheitsnetz e.V., Gemeinschaftspraxis Dr. Flohr | Dr. Sommer, Leipzig, Deutschland.
MMW Fortschritte der Medizin
|December 8, 2025
概括
在初级保健中对有风险的个体进行查,发现超过三分之一的患者患有慢性病 (CKD). 通过风险调整查的早期检测可以改善预后,强调尿液测量棒测试对CKD诊断的局限性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 初级医疗保健医学 一级医疗保健医学
- 公共卫生查 公共卫生查
背景情况:
- 慢性病 (CKD) 经常被低诊断.
- 尽管已有确定的适应症,但主要的诊断测试,如尿白蛋白-肌素比率 (UACR) 仍未得到充分利用.
研究的目的:
- 评估常规实践中对具有危险因素的患者进行CKD查的可行性和收益.
- 在这个人群中评估UACR的诊断性能和估计的膜过率 (eGFR).
主要方法:
- 预期查233名年龄在40至70岁之间,未先诊断患有CKD的患者.
- 纳入标准:心血管疾病的存在,家族病史,肥胖,糖尿病,高血压,心力衰竭或毒药物使用.
- 测量包括血清肌素 (对eGFR),尿液分析 (测量棒) 和斑点尿液UACR.
主要成果:
- 怀疑CKD的诊断是在35.6%的查患者中进行的.
- 在29.2%的患者中发现UACR升高 (≥30 mg/g).
- 在10.3%的患者中发现了降低的eGFR (<60毫升/分钟/1.73米2).
- 尿液测量棒测试的效用有限,20.6%的患者检测蛋白质正常,但UACR升高.
结论:
- 在一般实践中,风险调整查对于检测以前未被诊断的CKD是有效的.
- 这种方法可以识别出大量患者,他们可以从及时治疗和改善结果中受益.
- 尿液测量棒测试不足以排除CKD;UACR是一个更敏感的标记.
相关概念视频
01:28Chronic Kidney Disease III: Interprofessional Care
323
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
323
01:25Chronic Kidney Disease I: Introduction
545
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
545
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
244
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
244
01:18Chronic Kidney Disease IV: Nursing Management
299
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
299
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
174
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
174
01:24Chronic Kidney Disease II: Clinical Manifestations
529
Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
529