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2010CARI2型糖尿病患者的肾功能评估

2014-06-04 20:54阅读: 来源:爱爱医责任编辑:若你喜欢怪人
[导读] This guideline topic has been taken from the NHMRC'National Evidence Based Guidelines for Diagnosis, Preven-tion and Management of CKD in type 2 diabetes' whichcan be found in full at the CARI website (http://www.cari.org.au)。

    《2010CARI2型糖尿病患者的肾功能评估》内容简介:

    This guideline topic has been taken from the NHMRC'National Evidence Based Guidelines for Diagnosis, Preven-tion and Management of CKD in type 2 diabetes' whichcan be found in full at the CARI website (http://www.cari.org.au)。 The NHMRC guideline covers issuesrelated to the assessment and prevention of CKD in indi-viduals with established type 2 diabetes.

    《2010CARI2型糖尿病患者的肾功能评估》内容预览:

    The NHMRCguidelines do not address the care of people with diabeteswho have end-stage kidney disease (ESKD) or those whohave a functional renal transplant. In addition, the presentguideline does not provide recommendations regarding themanagement of individuals with established CKD, withrespect to the prevention of other (non-renal) adverse out-comes, including retinopathy, hypoglycaemia, bone diseaseand cardiovascular disease. It is important to note however,that in an individual with type 2 diabetes, the prevention ofthese complications may be a more important determinantfor their clinical care. Consequently, the recommendationsmade must be balanced against the overall managementneeds of each individual patient.

    There is a high intra-individual variability in 24 halbumin excretion with a coefficient of variation of 40-50%,therefore a diagnosis of persistent microalbuminuria shouldbe based on repeated measurements, especially if long-termtreatment of normotensive individuals are being considered.While increasing albuminuria is a risk factor for both CVDand ESKD, cross sectional studies have also shown a highdegree of heterogeneity in people with type 2 diabetes com-pared with type 1 diabetes with respect to CKD. As such asignificant proportion of people with type 2 diabetes mayhave CKD and be normoalbuminuric.3,6,7In the recentlyreported ARIC study (a population based prospective bira-cial long-term observational study of 2187 individuals withpredominantly type 2 diabetes), 30% of incident CKD(defined as eGFR < 60 mL/min per 1.73 m2or kidneydisease at hospitalization) did not have albuminuria(ACR 3 30 mg/g)。

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