CRF
definition
evaluation
general management
managemnt with associated disorder
serum creatinine
functional abnormalities for 3months
female>1.3 🚩
male>1.5 🚩
risk factor
⭐diabetes
hypertension :
hyperlipidemia
obesity
herb medicine
⭐age
CKD is a well-known factor for cardiovascular disease
Anemia-->LVHhypertrophy-->cardiac failure ♻
primary renal disease (potentially reversible causes:hypovolemia,hypotension,arterial blood volume, cirrhosis, nephrotic syn, occlusive renovascular disease
renal function密切追蹤 1--3months
electrolyte and acid base disturbance
anemia
mineral and bone disorder
cardiovascular disease
hyperparathyrodism
restrict dietary phosphate,an active D analogue,use phosphate binder
hyperphosphatemia
increase parathyroid hormone
inhibit 1,25 vitamine D synthesis
increase fibroblast
Direct vascular injury
drug interaction with phosphate binder
drugs:calcium carbonate,calcium acetate與磷酸跟結合
risk
smoking
sodium intake diet:<2.4g per day
weight
hypertension:<130/80mmHg
DM
Anemia
EPO synthesis,iron deficiency
use of EPO stimulating agent
⚠
注意transferrin saturation:20%-50%
ferritin:100-800 ng per millilter
non anion gap
increase anion gap
slow the rate
reduction of proteinuria
glycemic control
treatment of hypertension
slow the rate of progression of CKD: ACEI,ARB-first line choice
lower than130/80
減少diatery protein
ACEI+ARB:worsen renal outcomes
300-500mg/per day
降至0.8-1.0 per kg of BW
retention of organic acid
減少po4排出
減少renal ammonia合成