文档介绍：KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease
Am J Kidney Dis 49:S1-S180, 2007 (suppl 2)
主要内容：
II. CLINICAL PRACTICE GUIDELINES
Background: great burden of diabetes and CKD
GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETIC KIDNEY DISEASE
Patients with diabetes should be screened
annually for DKD (Diabetic kidney disease). Initial screening should commence:
● 5 years after the diagnosis of type 1diabetes; (A) or
● From diagnosis of type 2 diabetes. (B)
Screening should include:
● Measurements of urinary ACR (Albumin-creatinine ratio) in a spot urine sample (B)
● Measurement of serum creatinine and estimation of GFR (B)
GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETIC KIDNEY DISEASE
An elevated ACR should be confirmed in the absence of urinary tract infection with 2 additional first-void specimens collected during the next 3 to 6 months. (B)
● Microalbuminuria is defined as an ACR between 30-300 mg/g
● Macroalbuminuria is defined as an ACR > 300 mg/g
● 2 of 3 samples should fall within the microalbuminuric or macroalbuminuric range to confirm classification
GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETIC KIDNEY DISEASE
In most patients with diabetes, CKD should be attributable to diabetes if:
● Macroalbuminuria is present; (B) or
● Microalbuminuria is present
in the presence of diabetic retinopathy, (B)
in type 1 diabetes of at least 10 years’ duration. (A)
Definitions of Abnormalities in Albumin Excretion
GUIDELINE 1: SCREENING AND DIAGNOSIS OF DIABETIC KIDNEY DISEASE
Other cause(s) of CKD should be considered in the presence of any of the following circumstances: (B)
● Absence of diabetic retinopathy;
● Low or rapidly decreasing GFR;
● Rapidly increasing proteinuria or nephrotic syndrome;
● Refractory hypertension;
● Presence of active urinary sediment;
● Signs or symptoms of other systemic disease;
● >30% r