糖尿病肾病完整版.pptVIP

糖尿病肾病 糖尿病肾病概念 糖尿病肾病流行病学 糖尿病肾病ESRD的治疗 糖尿病肾病诊断 1 2 3 4 5 糖尿病肾病的早期防治 2007年NKF-KDOQI制定 糖尿病肾病诊治指南 第一个针对糖尿病并发慢性 肾脏病的指南，由两部分组成 糖尿病及慢性肾脏病的临床 实践指南(Clinical Practice Guidelines, CPG) 临床实践专家建议(Clinical Practice Recommendations，CPR) 关于糖尿病肾病名称的变更 传统概念：糖尿病肾病 Diabetic nephropathy，DN 2007年K/DOQI指南的新概念： 糖尿病肾脏疾病 Diabetic kidney disease，DKD 糖尿病肾小球病 Diabetic glomerulopathy，DG National Kidney Foundation. KDOQI Clinical Practice Guigelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kid Dis, 2007, 49(2 suppl 2): S1-S182 糖尿病肾病概念 糖尿病肾病流行病学 糖尿病肾病ESRD的治疗 糖尿病肾病诊断 1 2 3 4 5 糖尿病肾病的早期防治 de Boer IH. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. Jun 22 2011;305(24):2532-2539. The estimated numbers of persons with DKD in the United States at any given point in time increased from 3.9 million (95% CI,3.2-4.6 million) during 1988-1994 to5.5 million (95% CI, 4.8-6.3 million)during 1999-2004 to 6.9 million (95% CI, 6.0-7.9 million) during 2005-2008 The prevalence of DKD in the US population was 2.2% (95% confidence interval [CI], 1.8%-2.6%) in NHANES III, 2.8% (95% CI, 2.4%-3.1%) in NHANES 1999-2004, and 3.3% (95% CI, 2.8%-3.7%) in NHANES 2005-2008 (P <.001 for trend). 糖尿病：ESRD最常见的病因 2014 USRDS Annual Data Report.Volume 2: End-Stage Renal Disease The number of incident ESRD cases per year with diabetes or hypertension listed as the primary cause had been rising rapidly since 1980, but each have now declined over the most recent two years, from 2010 to 2012 The rate of new ESRD cases with diabetes listed as the primary cause has declined since 2006, with the lowest rate in 2012 since 1997 在糖尿病患者中肾脏病的发病率为30%~40% 我国大约有4千万糖尿病患者，其中1/3患有 DKD 糖尿病肾脏疾病流行病学 糖尿病肾病概念 糖尿病肾病流行病学 糖尿病肾病ESRD的治疗 糖尿病肾病诊断 1 2 3 4 5 糖尿病肾病的早期防治 糖尿病肾病的临床表现 根据疾病所处的不同阶段有所差异 主要表现为不同程度蛋白尿及肾功能的进行性减退。 糖尿病肾病的Mogensen 分期 糖尿病肾病病理改变 光镜下早期可见肾小球肥大，肾小球基底膜轻度增厚，系膜区轻度增宽。随着病情进展，肾小球基底膜弥漫增厚，基质增生，形成典型的K-W结节，称为结节性肾小球硬化症。部分患者无明显结节，称为弥漫