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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

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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 Tu,1, 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/OL]. 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/OL]. 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.

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