切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (04) : 187 -191. doi: 10.3877/cma.j.issn.2095-3216.2015.04.005

所属专题: 文献

专家论坛

老年慢性肾衰竭的诊断与治疗
涂卫平1,(), 黄翀1   
  1. 1. 330006 南昌大学第二附属医院肾内科
  • 出版日期:2015-08-28
  • 通信作者: 涂卫平

Diagnosis and treatment of chronic renal failure in the elderly

Weiping Tu1,(), Chong Huang1   

  1. 1. Renal Division, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
  • Published:2015-08-28
  • Corresponding author: Weiping Tu
  • About author:
    Corresponding author: Tu Weiping, Email:
引用本文:

涂卫平, 黄翀. 老年慢性肾衰竭的诊断与治疗[J]. 中华肾病研究电子杂志, 2015, 04(04): 187-191.

Weiping Tu, Chong Huang. Diagnosis and treatment of chronic renal failure in the elderly[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(04): 187-191.

老年慢性肾衰竭(CRF)起病隐匿、表现不典型、进展缓慢,容易误诊、漏诊或延误诊断。目前尚无有力证据证明哪一种估算肾小球滤过率(eGFR)的计算公式更适合用于老年CRF患者肾功能的评价。血清胱抑素C(Cys C)是近年提出的一项新的eGFR检测指标,对于Cys C在评价肾功能方面是否优于血清肌酐(Scr)值,特别是应用于老年人群,还需要更多的相关研究证实。老年人CRF的保守治疗包括:注意找出肾功能恶化的可逆因素,治疗伴随存在的其他系统性疾病,个体化实施低蛋白饮食,根据病情决定是否需限盐、限水,控制高血压,延缓慢性肾脏病(CKD)进展和心血管疾病的发生等;透析治疗是否可以有效改善老年CKD患者的预后,目前仅有观察性研究的结果,结论尚有争议;年龄本身不作为肾移植的禁忌条件,研究表明肾移植可以延长患者的生存时间和提高患者的生活质量。但由于老年人群的特殊性,肾移植前各方面情况的评估应更为谨慎。

Chronic renal failure (CRF) in elderly patients has insidious onset, atypical manifestation, and slow progression, which is prone to misdiagnosis, missed diagnosis, or delayed diagnosis. There is currently no convincing evidence that a certain estimated glomerular filtration rate (eGFR) formula is more suitable for the evaluation of renal function in elderly patients with CRF. Serum cystatin C (Cys C) is a recently-introduced new detection for eGFR. Whether Cys C is superior to serum creatinine (Scr) in assessing renal function of especially the elderly, still needs more related studies. The conservative treatment for the elderly CRF should include finding out the reversible factors for kidney function deterioration, performing treatment for other systems′ diseases, implementing individualized low protein diet, limiting salt or water intake according to the disease condition, controlling hypertension, and delaying chronic kidney disease (CKD) progression and cardiovascular disease occurrence; whether dialysis treatment can effectively improve prognosis of elderly CKD patients is still controversial, because currently there are only results of observational researches; and age itself is not a taboo condition for kidney transplantation. Studies have shown that kidney transplant can prolong the survival time and improve the quality of life of patients. Due to the particularity of kidney transplantation in the elderly, the assessment on all the aspects should be more cautious before the kidney transplantation.

[16]
Fontseré N, Esteve V, Saurina A, et al. The search for a new marker of renal function in older patients with chronic kidney disease stages 3-4:usefulness of Cys C-based equations [J]. Nephron Clin Pract, 2009, 112(3):c164-c170.
[17]
Emberson JR, Haynes R, Dasgupta T, et al.Cys C and risk of vascular and nonvascular mortality:a prospective cohort study of older men [J].J Intern Med,2010,268(2):145-154.
[18]
Stevens LA, Schmid CH, Greene T, et al.Factors other than glomerular filtration rate affect serum Cys C levels [J].Kidney Int,2009,75(6):652-660.
[19]
Keller T, Messow CM, Lubos E,et al. Cys C and cardiovascular mortality in patients with coronary artery disease and normal or mildly reduced kidney function:results from the AtheroGene study [J]. Eur Heart J, 2009, 30(3):314-320.
[20]
Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease [J]. Kidney Inter Suppl, 2012, 2(4): 279-335.
[21]
Kovedsky CP, Trivedi BK, Kalantar-Zadeh K, et al. Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease [J]. Nephrol Dial Transplant, 2006, 21(5): 1257-1262.
[22]
van Bemmal T, Woittiez K, Blauw GJ,et al.Prospective study of the effect of blood pressure on renal function in old age:the Leiden 85-Plus Study [J].J Am Soc Nephrol, 2006, 17(9): 2561-2566.
[23]
Weiss JW, Johnson ES, Petrik A, et al. Systolic blood pressure and mortality among older community dwelling adults with CKD [J]. Am J Kidney Dis, 2010, 56(6): 1062-1071.
[24]
Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency [J]. N Engl J Med, 2006, 354(2): 131-140.
[25]
Choudhury D, Levi M. Aging and kidney disease[M]//Brenner BM: The Kidney. 8th ed. Philadelphia: Sanders, 2007: 681-701.
[26]
Lerma EV, Ferder L, Johnson RJ. Geriatric Nephrology[M]//Feehally J. Comprehensive Clinical Nephrology. 3rd ed. Philadelphia: Sanders, 2007: 745-753.
[27]
Kooman JP, Cornelis T, van der Sande FM, et al. Renal replacement therapy in geriatric end-stage renal disease patients: a clinical approach [J]. Blood Purif, 2012, 33(1-3): 171-176.
[28]
Chandna SM, Da Silva-Gane M, Marshall C, et al. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy [J]. Nephrol Dial Transplant, 2011, 26(5): 1608-1614.
[29]
Kurella Tamura M. Incidence, management, and outcomes of end-stage renal disease in the elderly [J]. Curr Opin Nephrol Hypertens, 2009, 18(3): 252-257.
[30]
Cooper BA, Branley P, Bulfone L, et al. A randomized,controlled trial of early versus late initiation of dialysis [J]. N Engl J Med, 2010, 363(7): 609-619.
[31]
Dousdampanis P, Trigka K, Fourtounas C. Diagnosis and management of chronic kidney disease in the elderly: a field of ongoing debate [J]. Aging Dis, 2012, 3(5): 360-372.
[32]
Jassal SV, Krahn MD, Naglie G, et al. Kidney transplantation in the elderly: a decision analysis [J]. J Am Soc Nephrol, 2003, 14(1): 187-196.
[33]
Heldal K, Hartmann A, Grootendorst DC, et al. Benefit of kidney transplantation beyond 70 years of age [J]. Nephrol Dial Transplant, 2010, 25(5): 1680-1687.
[1]
Karam Z, Tuazon J. Anatomic and physiologic changes of the aging kidney [J]. Clin Geriatr Med, 2013, 29(3): 555-564.
[2]
陈香美,孙雪峰.共同参与有效防治老年肾脏病[N].中华医学信息导报,2014,29(5).
[3]
Bai X, Han L, Liu J,et al. The relationship between age-related kidney dysfunction and Framingham risk score in healthy people in China [J]. Curr Aging Sci, 2010, 3(3): 188-197.
[4]
Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey [J]. Am J Kidney Dis, 2003, 41(1): 1-12.
[5]
崔燕,王慧敏,魏玮.老年慢性肾脏病的常见病因及首发症状分析[J].中国全科医学,2012,15(4B):1244-1245.
[6]
刘胜,张晓英.老年人慢性肾功能衰竭的诊治[J].中华老年医学杂志,2006,25(3):236-238.
[7]
中华医学会肾脏病学分会.临床诊疗指南·肾脏病学分册[M].北京:人民卫生出版社,2009:204-213.
[8]
Botev R, Mallié JP, Couchoud C, et al. Estimating glomerular filtration rate:Cockcroft-Gault and modification of diet in renal disease formulas compared to renal inulin clearance [J]. Clin J Am Soc Nephrol, 2009, 4(5): 899-906.
[9]
Roberts GW, Ibsen PM, Schiøler CT.Modified diet in renal disease method overestimates renal function in selected elderly patients [J].Age Ageing, 2009, 38(6): 698-703.
[10]
Stevens LA, Schmid CH, Greene T, et al. Comparative performance of the CKD epidemiology collaboration (CKD-EPI)and the modification of diet in renal disease (MDRD) study equations for estimating GFR levels above 60 mL/min/1.73 m2 [J]. Am J Kidney Dis, 2010, 56(3): 486-495.
[11]
Nyman U, Grubb A, Sterner G, et al. The CKD-EPI and MDRD equations to estimate GFR validation in the Swedish Lund-Maim? Study cohort [J]. Scand J Clin Lab Invest, 2011, 71(2): 129-138.
[12]
Michels WM, Grootendorst DC, Verduijn M,et al. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age and body size [J]. Clin J Am Soc Nephrol, 2010, 5(6): 1003-1009.
[34]
Rebollo P, Ortega F, Baltar JM, et al. Health-related quality of life (HRQOL) in end-stage renal disease (ESRD) patients over 65 years [J]. Geriatr Nephrol, 1998, 8(2): 85-94.
[13]
Xun L, Cheng W, Hua T, et al.Assessing glomerular filtration rate (GFR) in elderly Chinese patients with chronic kidney disease (CKD): a comparison of various predictive equations [J].Arch Gerontol Geriatr, 2010, 51(1): 13-20.
[14]
Pei XH, Bao LH, Xu ZQ, et al. Diagnostic accuracy of cystatin C and glomerular filtration rate formulae in Chinese non-elderly and elderly populations [J]. J Nephrol, 2013, 26(3): 476-484.
[15]
Song S, Meyer M, Turk TR, et al. Serum cystatin C in mouse models: a reliable and precise marker for renal function and superior to serum creatinine [J]. Nephrol Dial Transplant, 2009, 24(4): 1157-1161.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志(电子版), 2023, 20(06): 622-630.
[3] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[4] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[5] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[6] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[7] 郭震天, 张宗明, 赵月, 刘立民, 张翀, 刘卓, 齐晖, 田坤. 机器学习算法预测老年急性胆囊炎术后住院时间探索[J]. 中华临床医师杂志(电子版), 2023, 17(9): 955-961.
[8] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[9] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[10] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[11] 卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要