preporuka za prevenciju i lečenje hronične bolesti bubrega

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

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    152

    1.

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

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

    1. [5]

    J, ml/min/1.73m2

    1.

    > 90

    2. 60 - 89

    3. 30 59

    4. 15 - 29

    5. < 15 ( )

    , , . , [5].

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    ,

    153

    2.

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

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

    2. 1.

    , . : , , 60 , . 2 , [5,12,13]. ,

    , , , - .

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    154

    2.

    60 (

    , )

    KDOQI , , , . , , 3:

    , [5].

    3. ,

    ,

    , ,

    ()

    , , , ,, ,,

    , , ,,

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    ,

    155

    2. 2.

    KDOQI

    , . , . , , .

    4.

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

    ,

    . ( , ).

    2 :

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

    3. 3.

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    156

    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 . - , - - , .

    . - ,

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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]. , , .

    ,

    . .

    3. 3.

    . , ,

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

    3. 4.

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

    (ml/min/1.73m2) =

    186 x{[ (mol/L)/88.4]1.154} * ()0.203* 0.742

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    160

    MDRD , ,

    . Cockcroft-Gault

    [35], :

    (ml/min) = [140()] * . (kg) * (0.85 )

    (mol/l) * 0.8136

    - 6. , - , . , - [10]. (>25 % y ) - - ( , , , -) [5].

    6.

    1. 2.

    , : -

    - - - -

    (, , , )3. (,

    , , , 5-ASA)

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    ,

    161

    3. 5.

    -

    . . , .

    , ,

    [5].

    , , , , , -

    . - , . .

    4.

    4.1.

    . , , - . -

    [36]. ,

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    162

    . -

    , . 7 , , KDOQI [5]. - , . , , - .

    7. 1

    :

    ,

    ,

    ,

    -

    30 ml/min/1,73 m2

    1 NKF KDOQI [5]

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    ,

    163

    4.2. /

    1 - / -. - , , , - . - , ,

    - 5 2.3. , - , (ACEI) -2 (AT2R). , , [37,38]. 1 a , ,

    [12].

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

    1000 mg /g. , , 60 , , e a, . .

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    164

    4. 3.

    2 . , , , . . , [13,39,40].

    4. 4.

    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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    ,

    165

    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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    166

    8.

    1. 130/80 mmHg

    2. ACEIAT2R ( ACEI )

    3. (HbA1c6.27.5%)4. ,

    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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    ,

    167

    4. 6.

    ACEI AT2R . , , . ACEI AT2R,

    [12]. :1. ACEI

    AT2R ,

    2. , ,

    3. , >20% -

    >15%4. , -

    ; , ,

    5. , - ACEI AT2R,

    6. (>6.0 mmol/l), - (. ), (, , ) , Henley- .

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    ,

    169

    ) . .

    , - .

    4. 8.

    , .

    [12]. , :

    1. 2. (

    20% )

    3. 30 ml/min/1.73 m2

    4. 5. (>7.0 mmol/l)6. 7. 8. , 9. ,

    .

    , : , .

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    170

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    ,

    173

    +

    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