Home >Documents >Curs 5 BCR 2015

Curs 5 BCR 2015

Date post:25-Feb-2018
Category:
View:217 times
Download:0 times
Share this document with a friend
Transcript:
  • 7/25/2019 Curs 5 BCR 2015

    1/56

    Curs 5 27 noiembrie 2015

    Prof. Univ. Dr. Eugen MoaProf. Univ. Dr. Eugen Moa

    Disciplina de NefrologieDisciplina de Nefrologie

    Universitatea de Medicina si Farmacie din Craiova

    Boala cronica de rinichiBoala cronica de rinichi

  • 7/25/2019 Curs 5 BCR 2015

    2/56

    1.Conceptul de Boala cronic derinichi2. Diagnosticul precoce al BCR

    3. Abordarea BCR n stadiile 3-54. Este posibil optimiarea ngri!iriiBCR

    Agenda

  • 7/25/2019 Curs 5 BCR 2015

    3/56

    C"ronic #idne$ Disease %C#D& C#D is a gradual and permanent loss o' (idne$

    'unction C#D most 're)uentl$ results 'rom anot"er

    disease t"at damages t"e (idne$s* primaril$diabetes or "ig" blood pressure

    As C#D progresses* (idne$ 'unction declines and

    e+entuall$ patients reac" End ,tage RenalDisease and need renal replacement t"erap$ %atransplant or dial$sis&

    CKD

  • 7/25/2019 Curs 5 BCR 2015

    4/56

    Kidney n!erna!iona" #u$$"emen!s %201&' &( 1)*+2

    KDIGO 2012 Guideline for Evaluation and Management of CKD

  • 7/25/2019 Curs 5 BCR 2015

    5/56

    5

    ,edu-erea$ersis!en! a ,/

    noma"ii* morfo"ogi-e rena"e* bio-3imi-e

    %s4nge sau urin'

    nsufi-ienarena" -roni-

    Eamen sumar deurin %di$6s!i-' %Crea!inin seri-'

    Es!imare ,/

    De!erminarea ra$or!u"ui"buminu8Crea!inin %,C' 9n urin

    s$on!an emis

    1

    2

    2 de!erminri "a & "uni

  • 7/25/2019 Curs 5 BCR 2015

    6/56

    KDIGO 2012 Guideline for Evaluation and Management of CKD

    Kidney n!erna!iona" #u$$"emen!s %201&' &( 1)*+2

  • 7/25/2019 Curs 5 BCR 2015

    7/56

    Kidney n!erna!iona" #u$$"emen!s %201&' &( 1)*+2

    KDIGO 2012 Guideline for Evaluation and Management of CKD

  • 7/25/2019 Curs 5 BCR 2015

    8/56

    Kidney Disease C"assifi-a!ion!o n-"ude "buminuria

    :3e ;a!iona" Kidney /ounda!ion 3as u$da!ed i!s-3roni- idney disease %CKD'-"assifi-a!ion sys!em!o in-"ude

    6 -ause6 g"omeru"ar fi"!ra!ion ra!e %/,'

    6 a"buminuria "eve"s

    Kidney Int. 201&

  • 7/25/2019 Curs 5 BCR 2015

    9/56

    Kidney n!erna!iona" #u$$"emen!s %201&' &( 1)*+2

  • 7/25/2019 Curs 5 BCR 2015

    10/56

    Kidney n!erna!iona" #u$$"emen!s %201&' &( 1)*+2

  • 7/25/2019 Curs 5 BCR 2015

    11/56

    ,tadiile BCR

    11

    #!adiu 1 #!adiu 2 #!adiu 5#!adiu &a #!adiu =

    De$"in -om$ensa!> ?Com$ensa!>Po"iurie

    ?De-om$ensa!> Uremie/Diali

    #!adiu &b

    ,e!en ie a@o!a! fi

    01m/min 1-m/min

    51-45m/min

    44-3m/min

    21-5m/min

    65m/mine78R

    Risc categ.2Risc categ.

    3

    Risc categ.

    RAC63

    RAC 3-3

    RAC 93

    Risc categ.2Risc categ.

    3

    Risc categ.

    Risc categ.3Risc categ.

    4

    Risc categ.2

    Risc categ.3Risc categ.

    4

    Risc categ.3

    Risc categ.4Risc categ.

    4

    Risc categ.4

    Risc categ.4Risc categ.

    4

    Risc categ.4

    Categoriile de risc %mortalitate general* C:* diali& e+aluate con'orme+e$ A et al* Kidney Int %2& ; raportul albumin/creatinin urinar== eR87 > 8iltratul glomerular estimat plec?nd de la creatinina ser

    Risc scaut

    Risc moderatcrescut

    Risc inalt

    Risc 'oarteinalt

  • 7/25/2019 Curs 5 BCR 2015

    12/56

    Epidemiologia BCR

  • 7/25/2019 Curs 5 BCR 2015

    13/56

    :3e g"oba" e$idemi- of -3roni- idney disease %CKD'

    is a signifi-an! $ub"i- 3ea"!3 issue affe-!ing u$ !o 10A

    of !3e adu"! $o$u"a!ion in !3e UK( and 11A in !3e U#.

    P,EBE;CE

    Medscape Diabetes & Endocrinology 2011

  • 7/25/2019 Curs 5 BCR 2015

    14/56

    0,3

    0,4

    7,6

    5,3

    5,9

    Milioane de pacieni

    15-29

    30-59

  • 7/25/2019 Curs 5 BCR 2015

    15/56

  • 7/25/2019 Curs 5 BCR 2015

    16/56

    Chronic !idne" diseaseChronic !idne" disease#$%DA&'$$#$%DA&'$$

    %. Mota 1(()(Maria Mota1(*()( +imona #opa2(*()( Adrian Co+ic ()* 7abriel @ircescu ()* Adalbert ,c"iller ()* @ircea enescu ()* Dan:lduiu ()* @irela 7"erman-Cprioar ()* Cristian ,eranceanu ()* iliana u ()* Costel ,p?nu ()* Constantin :eran ()* Aurel Bio()* Cristina Cpu ()* aul 7usbet"-atomir ()* iliana 7?rnea ()* Foan @i"ai aiu ()* G+idiu 7olea ()* :iorel Fancu ?tea ()

    1National Main Investigator, 2National Sub-Investigator, 3Romanian Society of Neprology, !Romanian Society of "iabetes, Nutritionand Metabolic "iseases, #Steering $ommitee

  • 7/25/2019 Curs 5 BCR 2015

    17/56

    De,nition of terms

    HC#D Ias dened as e78R 6 m/minper .

  • 7/25/2019 Curs 5 BCR 2015

    18/56

    C7D89 e0F$ :MD$D;3ml-min-1(5mp and-or

    AC$63mg-gC7D

  • 7/25/2019 Curs 5 BCR 2015

    19/56

    C7D89 e0F$ :C7D;3ml-min-1(5mp and-or

    AC$63mg-gC7D

  • 7/25/2019 Curs 5 BCR 2015

    20/56

    . Conceptul de Boala cronic de rinic"i2. Diagnosticul precoce al BC$

    3. Abordarea BCR n stadiile 3-54. Este posibil optimiarea ngri!irii BCR

  • 7/25/2019 Curs 5 BCR 2015

    21/56

    Diagnosticul BCR

    Diagnosticul Bolii cronice de rinic"ipresupune;* 2 consultaJii la 3 luni inter+al* 2 determinri creatinin seric :eF0

    3m4-min;* 2 determinri ale albuminei= Ki creatininei

    urinare= n urina spontan emis :$AC?3mg-g;

    &otal @3 $'N

  • 7/25/2019 Curs 5 BCR 2015

    22/56

    @L,MRAREA 8MNCOFEF RENAE

    Ce este R87P

    R87 este egal cu

    totalul ratelor ltrriine'ronilor 'uncionalidin rinic"i.

  • 7/25/2019 Curs 5 BCR 2015

    23/56

    E:AMAREA 8MNCOFEF RENAE

    Ce indic R87P

    $F0este acceptat ca ind cel maibun indeQ al 'unciei renale i sepoate estima utili?nd creatinina

    seric* seQul* +?rsta* greutatea irasa.

  • 7/25/2019 Curs 5 BCR 2015

    24/56

    sCr 120( CrC" 2) m"8min sCr 120( CrC" 1&0 m"8min

    EBU,E /U;C:E ,E;E

  • 7/25/2019 Curs 5 BCR 2015

    25/56

    E:AMAREA 8MNCFEF RENAE

  • 7/25/2019 Curs 5 BCR 2015

    26/56

    E:AMAREA 8MNCFEF RENAE

    Cum a'ectea +?rsta R87P

    R87 scade cu +?rsta c"iar i la pacieni 'arBCR.otui eQist o mare +ariabilitateindi+idual i moti+ele declinului nu suntcunoscute.

    G R87 scaut la +?rstnici este un predictorindependent el e+oluiei ne'a+orabile cum ar

    BC: i decesul.

  • 7/25/2019 Curs 5 BCR 2015

    27/56

    E:AMAREA 8MNCFEF RENAE

    ,cderea R87 la+?rstnicinecesit

    a!ustarea doelordemedicamente.

  • 7/25/2019 Curs 5 BCR 2015

    28/56

    E:AMAREA 8MNCFEF RENAE

    Ce este formula Croc!croft< 0ault

    A 'ost de+oltat n 1

  • 7/25/2019 Curs 5 BCR 2015

    29/56

    E:AMAREA 8MNCFEF RENAE

    Ce repreint ecuaia MD$D

    Este o ecuaie cu 4 +ariabile de+oltat n111 'olosind date de la 2 de pacienicu BCR i R87 5-1 ml/min/.

  • 7/25/2019 Curs 5 BCR 2015

    30/56

    Rata ltrrii glomerulare

    formula MD$D *

    R87 %ml/min/* *23& Q *

  • 7/25/2019 Curs 5 BCR 2015

    31/56

    %stimarea $F0 cu C"statin C

    C"statin C9 protein cu greutate molecularmic* produs de toate celulele nucleate* cu orata de producie constant* neinUuentat de

    dieta* +?rst sau masa muscular a pacientului.

    C$statin C ndeplineste criteriile de mar(erendogen al R87

    nu a intrat n practica ne'rologic curent* ind'olosit doar n cercetare

  • 7/25/2019 Curs 5 BCR 2015

    32/56

    %A4UA$%A FUNC&>%>$%NA4%

    Ce este ecuaia C7D

    C#D-EF 'ost de+oltat n 21 pentru aestima R87 utiliind creatinina serica*+?rst* seQ i ras i are o acurateeasemntoare cu @DRD in subgrupul de

    pacieni cu R876 ml/min i mult maimare in subgrupul cu R879 ml/min

  • 7/25/2019 Curs 5 BCR 2015

    33/56

  • 7/25/2019 Curs 5 BCR 2015

    34/56

    >denti,carea populaEiei larisc < Cauele BCR

  • 7/25/2019 Curs 5 BCR 2015

    35/56

    Primary Diagnosis for Pa!ien!s 3o #!ar! Dia"ysisPrimary Diagnosis for Pa!ien!s 3o #!ar! Dia"ysis

    Dia,ete-

    .0$1/

    perten-ion

    2*/

    Glomerulonephriti-

    1%/

    Other

    10/

    United States Renal Data System. Annual data report. 2000.

    o$ of patient-

    3ro4ection

    +./ CI

    1)= 1) 1))2 1))+ 2000 200= 2000

    100

    200

    &00

    =00

    500

    +00

    700

    r25++$(/2&%6.2&

    2(16%..

    .2062&0

    ;o

    .ofdia"ysis$a!ien!s

    %!3ousands'

    Diabe!es and Fy$er!ension 6:3e Mos! Common Causes of E#,D

    VoI Diabetes and Vig" Blood ressure

  • 7/25/2019 Curs 5 BCR 2015

    36/56

    VoI Diabetes and Vig" Blood ressureCause #idne$ Damage

    igh ,lood pre--uresi"en!"y damages !3e ar!eries and -a$i""aries(!3e added $ressure -auses !3e Ga""s of !3e vesse"s in !3e idney !obrea and s-ar

    n dia,ete-inf"amma!ion of b"ood vesse"s and -3anges in b"oodsugar "eve"s "ead !o damage of !3e idney

    :3ese redu-e !3e b"ood vesse" diame!er< fur!3er in-reasing b"ood$ressure and -ausing more damage

    FE:FH D#E#ED

    :3e /i"!ering Uni! of !3e Kidney * :3e "omeru"us

  • 7/25/2019 Curs 5 BCR 2015

    37/56

    Cauele BCR

    GWVare A@ et al* AX#D 22 51;53-52

    Cardiologie

    Dia.e

    tolo

    gi

    e

    Nefr

    olo

    gie

  • 7/25/2019 Curs 5 BCR 2015

    38/56

    opulaJia cu risc de BCR1. Diabe! @a3ara!

    2. F:

    &. I50 ani

    =. Jo"i -ardio6vas-u"are %P( M( BC( JBP'

    5. Jo"i s!ru-!ura"e a"e rini-3iu"ui( "i!i

Click here to load reader

Embed Size (px)
Recommended