10.4 3.0% 13.5% %
-*Am J Kidney Dis, 2008, 51:373-384.
Lancet. 2012 Mar 3; 379(9818): 815-22. IF: 39.06 nature:38.597 science:31.027
➢病因（考点） Causes
1.西方国家
糖尿病肾病和高血压肾小球动脉硬化是引起CKD的主要原因
hypertensive nephrosclerosis
27%
diabetic nephropathy
45%
others 15%
loss to follow-up 5% Glomerulonephritis 8%
United States Renal Data System ， USRDS Annual Data Report: Atlas of End-Stage Renal Disease in the US. 2002.
– 血/尿成分异常 Markers (urine, blood) – 影像学检查异常 Imaging – 病理学检查异常 Pathology
肾小球滤过率<60ml/min/1.73m2 , ≧ 3个月。 GFR <60 mL/min/1.73 ml
Chronic Kidney Disease (CKD)(名词解释)
▪ GFR < 60 mL/min/1.73 m2 for ≥ 3 months with or without kidney damage.
患病率（了解）Prevalence rate 全球透析人群增长趋势 全球透析费用增长趋势
➢ 慢性肾脏病的发病率在世界范围内呈上升趋势
国外：慢性肾脏病发病率为11%---16.2% 国内：
慢性肾脏病(CKD)的定义和分期（考点）2002/2012 Definition of Chronic Kidney Disease (CKD)
各种原因引起的肾脏结构和/或功能障碍超过3个月
Abnormalities of kidney structure or function, present for ≥3 months. 肾损害≧ 3个月 Kidney damage
内科学17、慢性肾衰竭
English language environment is very important
Study in Germany in 2013
内容提要 Main contents
概论 Introduction
定义 病因 疾病分期 危险因素
发病机理 Pathogenesis 临床表现 Clinical manifestation 诊断 Diagnosis 治疗 Treatment
1期 ≥90
Stages of CKD (考点，填空题)
In general, we divide CKD into five stages. Criteria of CKD Stage 1 is GRF >90 ml/min/1.73m2 Criteria of CKD Stage 2 is GRF 60-89 ml/min/1.73m2 Criteria of CKD Stage 3 is GRF 30-59 ml/min/1.73m2 Criteria of CKD Stage 4 is GRF 15-29 ml/min/1.73m2 Criteria of CKD Stage 5 is GRF <15 ml/min/1.73m2
▪ Kidney damage for ≥ 3 months, defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either ▪ Pathologic abnormalities ▪ Markers of kidney damage, such as abnormalities of the blood or urine
全国部分地区慢性肾脏病流行病学研究
地区
调查 例数
调查对 血尿 白蛋白 肾功能 慢性肾 象年龄 患病率 尿患病 下降患 脏病患
率 病率 病率
北京* 13925 ≥18岁 3.5% 9.2% 1.7% 11.3%
广州 2128 ≥20岁 6.5% 6.2% 1.6% 10.1%
浙江
1011
≥18岁
1.4%
一、概论
➢ 定义 Definitions
慢性肾衰竭（CRF）是指慢性肾脏病引起的肾小球 滤过虑（GFR）下降及与此相关的代谢紊乱和临床症 状组成的综合征，简称慢性肾衰
进行性，不可逆性（区别于ARF）。
Chronic renal failure(CRF)-- is characterized by progressive and irreversible loss of large numbers of functional nephrons.
慢性肾脏病分期(考点) Stages of CKD 2002年
发生率及特征（了解）
终末肾衰竭，ESRD 0.2％
GFR重度降低
0.2％
GFR轻到重度降低 4.3％
GFR轻度降低
31％
GFR正常或升高 64％
肾小球滤过率（掌握） ml/min/1.73m2
5期 ＜15
4期 15～29 3期 30～59 2期 60～89
Hale Waihona Puke 2.中 国慢性肾小球肾炎 Chronic glomerulonephritis 糖尿病肾病 Diabetic nephropathy 高血压肾小动脉硬化 Hypertensive nephrosclerosis 慢性肾盂肾炎 Chronic pyelonephritis 多囊肾 Polycystic kidney 狼疮性肾炎 Lupus nephritis 其它 Others
多囊肾 Polycystic kidney
病因（考点） Causes 填空
In the European and American countries, diabetic nephropathy and hypertensive nephrosclerosis is the main cause of chronic kidney disease (CKD), while in china, chronic glomerulonephritis is the main cause of CKD