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2002NKFCKD 10 CKDGFR CKD 1,330 8 1 CKD CKD 21 CKDCKD 20072009CKDKDIGO CKDGFR CKDCKD eGFReGFR GFRCGFR 70eGFR 40 mL//1.73 m2 CKDCKDCKDCKD

CKD2012

CKD12KAPDF.indd 1034 2015/01/06 15:12:08

CKD 10

CKD

CKD

KDIGO 2009 150

GFR 3GFR 3059 mL1.73 m2 GFR 45 mL1.73 m2

CKD

2012 KDIGO CKD cause

CGFRGA CGA

KDIGO CKD

CKD CKD

2012

KDIGO Board of Director 2012 AKI

GlomerulonephritisAnemiaBlood Pressure Definition, Classification, and

Stratification of CKD 5

CKD 2013

KDIGO

CKD 2012

CKD

CKD

1,300 ,

CKD

CKD

CKD 2012

Title:CKD12JO.ec6PDF Page:1035 Date: 2015/01/06 Tue 16:26:47

CKD2012

CKD

CKD

CKDch_PDF.indd 1036 15/01/06 16:09

CKD2012

CKDch_PDF.indd 1037 15/01/06 16:09

vi

CKD 2012 ii

CKD 2012 iii

CKD 2012 iv

CKD 2012 viii

CKD 2012 x

xii

1 CKD 13

CKD4

2 CKD 5

3 CKD 8CKD 11

4 CKDCVD 12CVD 14

5 15

61 18 CockcroftGault CKDEPI 21

62 22

7 25 26

27

28

81 CKD 29

82 CKD 36

9 CKD 40 CKDG3 eGFR 43

101 CKD 44

102 CKD 47

CKDmo_PDF.indd 6 15/01/06 16:09

vii

11 CKD 50

121 52 56

122 57

131 61

132 71

14 73

15 76

16 79

17 CKD 82 CKDD 83

FGF23 83

CKD 83

18 CKD 84

19 K 87K 89

20 90

21 91 93

22 CKD 94

100

129

131

CKD

eGFR

CKDmo_PDF.indd 7 15/01/06 16:09

viii

1CKD GFR60 mL//1.73m2 3

2 GFReGFReGFRcreat C eGFRcys

3CKD CauseCGFRGA CGA

4CKD CVD ESKD

5CKD

6

7CKD

8CKD 130/80 mmHg

CKD 2012

eGFRcreat(mL//1.73m2)=194Cr-1.094-0.287

eGFRcys(mL//1.73m2)=104Cys-C-1.0190.9968

eGFRcreat(mL//1.73m2)=194Cr-1.094-0.2870.739eGFRcys(mL//1.73m2)=104Cys-C-1.0190.9960.9298 18

1) 0.50 g/gCr 2+2) 1+3) 40 GFR 60 mL//1.73m240 70 GFR 50 mL//1.73m270 GFR 40 mL//1.73m2

CKD12ESPDF.indd 8 2015/01/06 15:12:26

ix

CKD2012

9 140/90 mmHg 130/80 mmHg 110mmHg

10 0.15g/gCr 30 mg/gCr ACE ARB

11 0.15 g/gCr

120.50 g/gCr 0.50 g/gCr RAS

13ACE ARB (eGFR ) K

14 HbA1c6.9%NGSP

15CKD CVD LDL 120 mg/dL

16CKD 100 ng/mL TSAT20%

17erythropoiesis stimulating agent: ESAHb1012 g/dL

18CKD G3a P, Ca, PTH, ALP

19CKD G3a K

20CKD

CKD12ESPDF.indd 9 2015/01/06 15:12:26

x

1Cr eGFR 2 11 eGFR 0.3m/ Cr 100

2

3 CKD CAKUT

4CAKUT 3

5CAKUT

62012

CKD2012

1g/gCr10.20.4 g/gCr61220.50.9 g/gCr3631.01.9 g/gCr13 26

2 33.0 g/dL456

PDF.indd 10 2015/01/06 15:15:00

xi

CKD2012

7

8 90

9

10 1/2GFR60mL//1.73m2

11transition/

PDF.indd 11 2015/01/06 15:15:00

xii

ACE angiotensin converting enzyme

ACR albumin-creatinine ratio /

AKI acute kidney injury

ARB angiotensin II (type 1a) receptor blocker

BSA body surface area

CAKUT congenital abnormality of kidney and urinary tract

CKD chronic kidney disease

CKD-MBD CKD-mineral and bone disorder CKD

CVD cardiovascular disease

eGFR estimated GFR

eGFRcreat estimated GFR creatinine Cr

eGFRcys estimated GFR cystatin C Cys-C

ESKD end-stage kidney disease

GFR glomerular filtration rate

IGT impaired glucose tolerance

KDIGO Kidney DiseaseImproving Global Outcomes

MCDK multicystic dysplastic kidney

MRA magnetic resonance angiography

MRU magnetic resonance urography

NSF nephrogenic systemic fibrosis

PAD peripheral artery disease

PKD polycystic kidney disease

RPGN rapidly progressive glomerulonephritis

SAS sleep apnea syndrome

TDM therapeutic drug monitoring

VCUG voiding cystourethrography

VUR vesicoureteral reflux

CKDr_PDF.indd 12 15/01/06 16:09

1

2

4

3

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

INDEX

1CKD

2CKD

3CKD

4CKD CVD

5

6162

7

81 CKD82 CKD

9CKD

101CKD102CKD

11CKD

121122

131132

14

15

16

17CKD

18CKD

19 K

20

21

22CKD

CKDINDEX_PDF.indd 1043 15/01/06 16:10

1

1

2

4

3

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1CKD

CKD 1 GFR3 K

2CKD

CKD 0.15 g/gCr GFR60 mL//1.73 m2 GFRCr GFR GFReGFR6

g/gCr7

3

1 CKD

CKD glomerular filtration rateGFR60 mL1.73 m2

3 CKD CauseCGFRGACGA CKD CG1G5A1A3

1CKD

0.15 ggCr

30 mggCr

GFR60 mL1.73 m2

3

CKD1215PDF.indd 1 2015/01/06 14:43:54

2

CKD 3 0.15 g/gCr

3 30 mg/gCr

3 CreGFR 60 mL//1.73 m2

CKD

CKDg/gCr

3 30 mg/gCr 30 mg/gCr

Cr eGFR60 mL//1.73 m2eGFR 60 mL//1.73 m2 CKD

3CKD

CKDCauseCGFRGACGACKD CKDGFRG3GFR 4559 mL//1.73 m2 G3a 3044 mL//1.73 m2G3b Ddialysis D

G5D 24/ ACR30 mg/gCr30299 mg/gCr300 mg/gCr0.15 g/gCr0.150.49 g/gCr0.50 g/gCrACR 2,000 mg/gCr 3.5 g/gCrCKDGFR ACR 2 G2A3 G3bA1 G4A1 G3aA1 CKD G4A2CKD ESKD GFR GFR GFR GFR CKD G3aG3bG4G5CKDESKD 3 ESKDESKD

CKD1215PDF.indd 2 2015/01/06 14:43:54

3

1

2

4

3

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1CKD

2CKD

A1 A2 A3

mg

Cr mggCr

30 30299 300

g

Cr ggCr

0.15 0.150.49 0.50

GFRmL1.73 m2

G1 90

G2 6089

G3a 4559

G3b 3044

G4 1529

G5 ESKD 15

GFR CKD KDIGOCKDguideline2012

1 150 mgBence Jones L

400 235 1 L12 mLCKD

CKD1215PDF.indd 3 2015/01/06 14:43:55

4

CKD

2002 K/DOQI CKD GFR60 mL//1.73 m23GFRCKD GFR2009 10CKD 156CKDAKI eGFRCKDeGFR GFR30 mg/gCr30299 mg/gCr

300 mg/gCrCKD 3 G3aeGFR 4559 mL//1.73 m2G3beGFR 3044 mL//1.73 m2 CKD 3 12656565 eGFR 60 mL//1.73 m2

GFRCKD 2012GFRGFR

LeveyAS.KidneyInt2011801728.

3CKD

ACRCr mggCr

ACR10

ACR1029

ACR30299

ACR300

eGFR105 0.9 1.3 2.3 2.1

eGFR90104 Ref 1.5 1.7 3.7

eGFR7589 1.0 1.3 1.6 3.7

eGFR6074 1.1 1.4 2.0 4.1

eGFR4559 1.5 2.2 2.8 4.3

eGFR3044 2.2 2.7 3.4 5.2

eGFR1529 14 7.9 4.8 8.1

ACR10

ACR1029

ACR30299

ACR300

eGFR105 Ref Ref 7.8 18

eGFR90104 Ref Ref 11 20

eGFR7589 Ref Ref 3.8 48

eGFR6074 Ref Ref 7.4 67

eGFR4559 5.2 22 40 147

eGFR3044 56 74 294 763

eGFR1529 433 1,044 1,056 2,286

CKD1215PDF.indd 4 2015/01/06 14:43:55

5

1

2

4

3

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1ESKD

ESKD19902000 10ESKD 43 106.52008 165 1

2011 30 100 2,126 2

2ESKDCKD

CKD ESKD 2000 CKD

2 CKD

endstagekidneydiseaseESKD131,330CKDCKDCKDESKDcardiovasculardiseaseCVD

1ESKDLysaght MJ. J Am Soc Nephrol 200213S37S40. 2010 12 31

1980 1990 2000 2007

106.5

27.6

20.6

42.6

12.8

10.3

15.8

5.3

3.6

2010

200.0

50.0

20.0

10.0

27.5 29.7

165209.5

54.3

53.5

CKD1201PDF.indd 5 2015/01/06 14:44:37

6

4CKD20

GFR

GFRmL1.73 m2

1

G1 90 2,803 61 0.6

G2 6089 6,187 171 1.7

G3a 4559 886 8.6 58 0.6

G3b 3044 106 1.0 24 0.2

G4 1529 10 0.1 9 0.1

G5 15 1 0.01 4 0.03

CKD 23 CKD

2abmacroalbuminuriaGFR 60 mL1.73 m2

Matsushita K, et al. Lancet 201037520732081.

HR95Cl

16

8

4

2

1

0.515 30 45 60 75 90 105 120

eGFRmL//1.73 m2

a b

21

16

8

4

2

1

0.515 30 45 60 75 90 105 120

eGFRmL//1.73 m2

HR95Cl

16

8

4

2

1

0.5

16

8

4

2

1

0.5

CKD1201PDF.indd 6 2015/01/06 14:44:37

7

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20

21

22

2CKD

13.072,561 2005 CKD12.91,330 1,329CKD 4 CKD CKDGFR 50 mL//1.73 m29CKD

3CKD

CKDcardiovascular diseaseCVD CKD CVD

CKD CVD GFR 60 mL//1.73 m2CVDGFR 2 CVDCVD/ 2 CKDCKDCVD 3

4CKD

2004Kidney DiseaseImproving Global OutcomesKDIGOCKD 3 2 Cr CKD 2009 2010

3CKDCVDCKD

N1,306N462N283N6431Nakayama M, et al. Hypertens Res 201131