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8/10/2019 Preporuka Za Prevenciju i Leenje Hronine Bolesti Bubrega

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/ () 60 ml/min/1,73m2 [5]. , (, , , ,) - (, .) . ,

( 1) KDOQI(Kidney Disease Outcomes Quality Ini-tiative) [5], .

1. [5]

J, ml/min/1.73m2

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> 90

2. 60 - 89

3. 30 59

4. 15 - 29

5. < 15 ( )

, , . , [5].


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153

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( ), . , [5,12,13, 15]. , .

, [16,17]. - [18] , .

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, )

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, [5].

3. ,

,

, ,

()

, , , ,, ,,

, , ,,


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, . , . , , .

4.

1. (, , , 2., ( )) 3.

,

. ( , ).

2 :

, 1. , , - ()( 4). 2. , , .

3. 3.


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2. 3.

-

, - , -, [2,5]. 5 , , [5,19,20]. - 130/80 mmHg , - [21]. / -

, [22,23]. - (HbA1c6.57.5%) , [24-26].

5.

1.

2. ( 130/80

mmHg)

3. ( - 5,1-6,5

mmol/l;HbA1c 6,27,5%)

4.

5. : 100 mmol/

, 65-100 mmol/

6.

7. : 30 - 60 (, , ) 4 7

8. ( 18,5 kg/m2 24,9 kg/m2,

102 cm , 88 cm )

9. : 2

10.

11.


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157

, . , - ( 5) [12,13].

( - 20-25 kg/m2), , [5,12]. , - , - [12].

3.

( 3). , , - ( 4). - [13,27,28].

3.1.

- . 24 . , [13]. , 1+ , - () . mg/mg , mg/mmol. - g/l, mol/l. 0,5g/l 17 000 mol/l 88,4 - mg/dl.


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158

: 0,5g/l= 50 mg/dl : 17 000 mol/l= 17000/88,4 mg/dl= 192 mg/dl/ : 50/192 = 0.260 mg/mg

: 0,5g/l= 500 mg/l : 17 000 mol/l= 17 mmol/l/ : 500/17= 29.4 mg/mmol

< 0,2 mg/mg, 0,2g/g < 22 mg/mmol

-

, [13], 45 mg/mmol [12].

- , - - .

3.2.

- . - , [29-32]. ,

. -

30 mg/24. , 24 . - , - - , .

. - ,


11/26

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159

2,5 mg /mmol , 3,5 g/mmol [12], 17 mg /g 25 mg /g [33],

30 mg/g (3,4 mg/mmol ) [5,13,14,34]. , , .

,

. .

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. , ,

. , . - , , ,, , [5,13].

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- Modification of Diet in Renal Disease MDRD [21]. , , . MDRD.

(ml/min/1.73m2) =

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MDRD , ,

. Cockcroft-Gault

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(mol/l) * 0.8136

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1 NKF KDOQI [5]


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163

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[12].

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60 89 ml/min/1,73m2

MDRD 60 ml/min/1,73m2 , - . 3 . 30 - . . , 60 89 ml/min/1,73m2 , , . , ( 5). 60 89 ml/min/1,73m2 1 2.

4. 5.

30 59 ml/min/1,73m2

60 ml/min/1,73m2 - , . . . :


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1. 2.

(,3.) 4.ACEI5. AT2R [5]6.

, . , -

. 4 -

30 - 59 ml/min/1,73m2 . . 1g/g, , .

60 ml/min/1,73m2

8. , . , , 25%, , . , .

60 ml/min/1,73m2 , .


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8.

1. 130/80 mmHg

2. ACEIAT2R ( ACEI )

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5. , 6. 7. , 8.

9. 100 mmol/10. (,

, )11. , 12. 13. 14. 15.

. [41,42] 70 60 ml/min/1,73m2 . , [43]. , 70 30 59 ml/min/1,73m2

/ , 45 ml/min/1,73m2 .

( 30 59 ml/min/1,73m2) , , , , .

.


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ACEI AT2R . , , . ACEI AT2R,

[12]. :1. ACEI

AT2R ,

2. , ,

3. , >20% -

>15%4. , -

; , ,

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169

) . .

, - .

4. 8.

, .

[12]. , :

1. 2. (

20% )

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.

, : , .


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Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term1.implications. J Am Soc Nephrol 2002;13: S37S40.Bello AK, Nwankwo E, El Nahas AM. Prevention of chronic kidney disease: A global2.challenge. Kidney Int 2005; 68 (Suppl 98):S11S17.U. S. Renal data System: USRDS 2001 Annual Data Report: Atlas of End-Stage Renal3.Disease in the United States, Bethesda, MD, National Institutes of Health, NationalInstitute of Diabetes and Digestive and Kidney Diseases, 2001.Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S, Hallan HA, Lydersen4.S, Holmen J. International Comparison of the Relationship of Chronic Kidney DiseasePrevalence and ESRD Risk. J Am Soc Nephrol 2006; 17:227584.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney5.disease: evaluation, classication and stratication. Am J Kidney Dis 2002; 39 (2 Suppl

1):S1-S266. http://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htmCoresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS.6.Prevalence of Chronic Kidney Disease in the United States J Am Med Assoc 2007; 298(17):2038-2047.Hostetter TH. Chronic Kidney Disease Predicts Cardiovascular Disease N Engl J Med7.2004; 351:1344-1346.Go A.S., Chertow G.M., Fan D., McCulloch C.E., Hsu C-Y. Chronic kidney disease8.and the risks of death, cardiovascular events and hospitalization. N Engl J Med 2004;351:12961305.Weiner DE, Tighiouart H, Amin MG et al. Chronic kidney disease as a risk factor for9.cardiovascular disease and all-cause mortality: a pooled analysis of community-basedstudies. J Am Soc Nephrol 2004; 15:130715.Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among10.a population with chronic kidney disease in a large managed care organization. ArchIntern Med2004; 164:659-63.Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in11.chronic renal disease. Am J Kidney Dis 1998; 32:S112S119.Joint Specialty Committee on Renal Medicine of the Royal College of Physicians12.and the Renal Association, and the Royal College of General Practitioners.Chronic kidney disease in adults: UK guidelines for identication, management andreferral.London: Royal College of Physicians, 2006.

http://www.rcplondon.ac.uk/pubs/books/kidney/The CARI guidelines. Caring for Australasians with Renal Impairment. Sydney:13.

Australian and New Zealand Society of Nephrology. 2004. http://www.cari.org.au/guidelines.phpLevin A, Hemmelgarn B, Culleton B, et al; Canadian Society of Nephrology. Guidelines14.for the management of chronic kidney disease. CMAJ. 2008; 179(11):1154-62. http://www.cmaj.ca/cgi/data/179/11/1154/DC1Boulware LE, Jaar BG, Tarver-Carr ME et al.15. Screening for proteinuria in US adults: Acost-effectiveness analysis.JAMA 2003; 290:310114.Frankel A., Brown E., Wingeld D. Management of chronic kidney disease. Primary16.and secondary care need to set up a model of combined care. BMJ2005;330:1039-40.Department of Health: The National Service Framework for Renal Services. Part I17.and Part II. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4101902

ukanovi Lj, Leai V. Rano otkrivanje bolesti bubrega (ROBB studija). Pregled18.i analiza rezultata. In: ukanovi Lj i Leai V, urednici. Rezultati studije Ranootkrivanje bolesti bubrega. Monograje Akademije medicinskih nauka SLD. Serija B.


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,

171

2009; 3:171-186.McClellan WM, Ramirez SPB, Jurkovitz19. C. Screening for Chronic Kidney Disease:Unresolved Issues. J Am Soc Nephrol 2003; 14:S81-S87.Dirks JH, De Zeeuw D, Agarwal SK et al. Prevention of chronic kidney and vascular20.

disease: Toward global health equityThe Bellagio 2004 Declaration. Kidney Int 2005;68 (Suppl 98):S1S6.Peterson JC, Adler S, Burkart JM, Greene T, Hebert LA, Hunsicker LG, King AJ, Klahr21.S, Massry SG, Seifter JL. Blood pressure control, proteinuria and the progressionof renal disease: The Modication of Diet in Renal Disease Study. Ann Intern Med1995;123:754-62Parving HH, Andersen AR, Smidt UM: Early aggressive antihypertensive treatment22.reduces rate of decline in kidney function in diabetic nephropathy. Lncet 1983;1: 1175-79.Jovanovi D, ukanovi Lj, Naumovi R.23. Slowing down chronic renal failureprogression with various antihypertensive agents. Clin Nephrol 1998; 50:390-91.The effect of intensive treatment of diabetes on the development and progression of24.

long-term complications in insulin-dependent diabetes mellitus. The Diabetes Controland Complications Trial Research Group. N Engl J Med 1993; 329:977-86.Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto25.Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care 2000; 23Suppl 2:B21-9.Intensive blood-glucose control with sulphonylureas or insulin compared with26.conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53.Sesso R, Belasco AG. Late diagnosis of chronic renal failure and mortality on27.maintenance dialysis. Nephrol. Dial. Transplant1996; 11:241720.Kinchen KS, Sadler J, Fink N, Brookmeyer R, Klag MJ, Levey AS, and Powe NR. The28.Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality. Ann InternMed2002; 137:479-486.Hillege HL, Fidler V, Diercks GFH,29. et al. Urinary albumin excretion predictscardiovascular and noncardiovascular mortality in general population. Circulation2002; 106:177782.Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-30.stage renal disease. Kidney Int 2003;63:1468-74.Hostetter TH. Chronic Kidney Disease Predicts Cardiovascular Disease N Engl J Med31.2004; 351:1344-46.Foster MC, Hwang S-J, Larson MG,32. et al. Cross-classication ofmicroalbuminuria andreduced glomerular ltration rate. Arch InternMed 2007; 167:138692.

Mattix H, Hsu C-Y, Shaykevich S, Curhan G. Use of the albumin/creatinine ratio33. to detect microalbuminuira: Implications of sex and race. J Am Soc Nephrol 2002;13:1034-1039.Nacionalni komitet za izradu Vodia klinike prakse u Srbiji. Radna grupa za dijabetes34.Neboja Lali i sar. Beograd: Graka ovi. 2002. p. 59-61.Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.35.Nephron 1976;16:3141.ukanovi Lj, Leai V, Dimkovi N. Preporuke za interpretaciju rezultata skriniga,36.nastavak ispitivanja i leenje bolesnika. U: ukanovi Lj i Leai V, urednici. Rezultatistudije Rano otkrivanje bolesti bubrega. Monograje Akademije medicinskih naukaSLD. Serija B. 2008;3:201-212.Jaffar TH, Schmid CH, Landa M et al. Angiotensin-converting enzyme inhibitors and37.

progression of nondiabetic renal disease. A meta-analysis of patient-level data. AnnIntern Med 2001; 135(2):73-87.Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin38.receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N


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Engl J Med 2001;345(12):851-60.Sutton JM. Evaluation of hematuria in adults. JAMA 1990; 263:2475-80.39.Kovaevi Z, Jovanovi D, Rabrenovi V, Dimitrijevi J, ukanovi Lj. Asymptomatic40.microscopic hematuria in young males. Int J Clin Pract 2008; 62:406-412.

Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal41.function with age. J Am Geriatr Soc 1985; 33:27885.Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence,42.and trends among US adults. J Am Soc Nephrol 2005; 16:180-8.Glassock R. and Winerals C. An epidemic of chronic kidney disease: fact or ction.43.Nephrol Dial Transplant2008; 23:1117 21.


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+

3

200 mg/g

200 mg/g

17 25 mg/g

17 25 mg/g

ACEI/AT2R

1000 mg/g

1000 mg/g

+/-

> 50 < 50

1000 mg/g

1000 mg/g

+ -

1.

2.


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60 - 89 ml/min/1,73m2

> 60 < 60

6

1 2

30 - 59 ml/min/1,73m2

2

+/-

6

*

3. 60 89 ml/min/1,73m2

4. 30 59 ml/min/1,73m2

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