慢性肾衰竭
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Glomerulopathies associated with systemic disease
Hereditary nephropathies
Obstructive uropathy
Focal glomerulosclerosis Idiopathic crescentic glomerulonephritis IgA nephropathy Membranoproliferative glomerulonephritisMembranous nephropathy
Now more commonly classified as chronic kidney disease（CKD） and is listed as stages based on the patient's level of glomerular filtration rate (GFR) which is a measure of filtering capacity of the kidneys.
Classification of CKD
stage
description
GFR
（ml/min/1.73m2）
1 Kidney damage with normal or increased GFR
≥90
2
Kidney damage with mild decrease in GFR
60～89
3
Moderate decrease in GFR
GFR < 60 ml/min/1.73 m2 for 3 months, with or without kidney damage
defined by the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI). 2002
DefinLeabharlann Baidution of CKD
Kidney damage for 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either: • Pathological abnormalities • Markers of kidney damage, including abnormalities in the composition of the blood or urine or abnormalities in imaging tests
慢性肾衰竭
Chronic Renal Failure
中南大学湘雅二医院肾内科 袁曙光
Definition of CRF
A pathological process that the kidneys are affected progressively by the insults and thus an irreversible loss of large numbers of function nephrons occurs.
Benign prostatic hyperplasia Posterior urethral valves Retroperitoneal fibrosis Ureteral obstruction
中国透析患者构成比 Prevalence of CKD in China 10.8%
Propotion of the caused diseases in
Definition
Chronic Renal Failure Chronic Kidney Disease End-Stage Renal Disease Uremia CKD 4，5 / CRF CKD 5 / ESRD / Uremia
Etiology of CKD
Glomerulopathies (primary)
Diabetes mellitus Hemolytic-uremic syndrome Hypertension SLE Wegener's granulomatosis
Hereditary nephritis (Alport's syndrome) Medullary cystic disease Nail-patella syndrome Polycystic kidney disease
Etiology of ESRD
Pathogenesis
20世纪80年代由Brenner提出: 5/6肾切除后，残余肾脏存在单个肾单位三高现象－
三高学说
高滤过－肾小球滤过率增高 高灌注－血浆流量增高 高压力－毛细血管跨膜压增高
三高结果：
肾小球上皮细胞足突融合，系膜细胞和基质显著增生，肾小球肥大，硬化 肾小球内皮细胞损伤，诱发血小板聚集，导致微血栓形成，促进肾小球硬化 肾小球通透性增加，尿蛋白增加损伤肾小管间质
肾小球高滤过是促使CKD进展的重要原因
血管紧张素II与肾脏损伤
肾小球压力性损伤 氧化应激 蛋白尿 Nuclear factor-kB活化
30～59
CRF分期
肾功能代偿期 氮质血症期
SCr
（mol/L）
133-177 186-450
症状
无 轻度贫血、夜尿 增多
4 Severe decrease in GFR 15～29
贫血、酸中毒、 尿毒症早期 450-707 消化道症状
5
Kidney failure/ESRD
<15
尿毒症期
>707 各种尿毒症症状
Dialysis population
HPtN, 13% ADPKD, 2%
肾小球疾病
45%
unknown, 20%
糖尿病肾病,
19%
Gl omer ul us nephr i t i s
DN
unknown
HPt N
ADPKD
Epidemiology and Particular Features of Glomerular Diseases in China Presented By Prof Wang Haiyan -China
Hereditary nephropathies
Obstructive uropathy
Focal glomerulosclerosis Idiopathic crescentic glomerulonephritis IgA nephropathy Membranoproliferative glomerulonephritisMembranous nephropathy
Now more commonly classified as chronic kidney disease（CKD） and is listed as stages based on the patient's level of glomerular filtration rate (GFR) which is a measure of filtering capacity of the kidneys.
Classification of CKD
stage
description
GFR
（ml/min/1.73m2）
1 Kidney damage with normal or increased GFR
≥90
2
Kidney damage with mild decrease in GFR
60～89
3
Moderate decrease in GFR
GFR < 60 ml/min/1.73 m2 for 3 months, with or without kidney damage
defined by the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI). 2002
DefinLeabharlann Baidution of CKD
Kidney damage for 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either: • Pathological abnormalities • Markers of kidney damage, including abnormalities in the composition of the blood or urine or abnormalities in imaging tests
慢性肾衰竭
Chronic Renal Failure
中南大学湘雅二医院肾内科 袁曙光
Definition of CRF
A pathological process that the kidneys are affected progressively by the insults and thus an irreversible loss of large numbers of function nephrons occurs.
Benign prostatic hyperplasia Posterior urethral valves Retroperitoneal fibrosis Ureteral obstruction
中国透析患者构成比 Prevalence of CKD in China 10.8%
Propotion of the caused diseases in
Definition
Chronic Renal Failure Chronic Kidney Disease End-Stage Renal Disease Uremia CKD 4，5 / CRF CKD 5 / ESRD / Uremia
Etiology of CKD
Glomerulopathies (primary)
Diabetes mellitus Hemolytic-uremic syndrome Hypertension SLE Wegener's granulomatosis
Hereditary nephritis (Alport's syndrome) Medullary cystic disease Nail-patella syndrome Polycystic kidney disease
Etiology of ESRD
Pathogenesis
20世纪80年代由Brenner提出: 5/6肾切除后，残余肾脏存在单个肾单位三高现象－
三高学说
高滤过－肾小球滤过率增高 高灌注－血浆流量增高 高压力－毛细血管跨膜压增高
三高结果：
肾小球上皮细胞足突融合，系膜细胞和基质显著增生，肾小球肥大，硬化 肾小球内皮细胞损伤，诱发血小板聚集，导致微血栓形成，促进肾小球硬化 肾小球通透性增加，尿蛋白增加损伤肾小管间质
肾小球高滤过是促使CKD进展的重要原因
血管紧张素II与肾脏损伤
肾小球压力性损伤 氧化应激 蛋白尿 Nuclear factor-kB活化
30～59
CRF分期
肾功能代偿期 氮质血症期
SCr
（mol/L）
133-177 186-450
症状
无 轻度贫血、夜尿 增多
4 Severe decrease in GFR 15～29
贫血、酸中毒、 尿毒症早期 450-707 消化道症状
5
Kidney failure/ESRD
<15
尿毒症期
>707 各种尿毒症症状
Dialysis population
HPtN, 13% ADPKD, 2%
肾小球疾病
45%
unknown, 20%
糖尿病肾病,
19%
Gl omer ul us nephr i t i s
DN
unknown
HPt N
ADPKD
Epidemiology and Particular Features of Glomerular Diseases in China Presented By Prof Wang Haiyan -China