l

l



l


l

2555
31,250

(Chronic kidney disease)
17.5

2555



l
l
l

l

1
6
9
10
13
18


Abbreviation Key:
ACEI Angiotensin Converting Enzyme Inhibitor
ARB Angiotensin Receptor Blocker
CKD Chronic Kidney Disease
ESA Erythropoiesis Stimulating Agent
NSAID Non Steroidal Anti inflammatory Drug
UPCR Urine Protein: Creatinine Ratio
PTH Parathyroid Hormone
SLE Systemic Lupus Erythematosus

 (Chronic kidney disease)

(End stage renal
disease)

3 2.9-13%(1-5)
70



40%

1.9 1.6 (3)

 1.9%
(4)

 1.

macroalbumin

(protin 1+ )

eGFR*

microalbumin**

eGFR 60
ml/min/1.73 m2

eGFR 30-59
ml/min/1.73 m2

eGFR <30
ml/min/1.73 m2

. ./PCU
1

* (estimated GFR;eGFR) (serum creatinine, SCr)

CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
eGFR CKD-EPI

serum creatinine

(mg/dl)
< 0.7
GFR = 144 (SCr/0.7)-0.329 (0.993)Age

> 0.7
GFR = 144 (SCr/0.7)-1.209 (0.993)Age
< 0.9
GFR = 141 (SCr/0.7)-0.411 (0.993)Age

> 0.9
GFR = 141 (SCr/0.7)-1.209 (0.993)Age
** microalbumin
, , ,
microalbumin microalbumin 2 3 3-6
1) microalbuminuria dipstick
2) urinary albumin/creatinine ratio (UACR) 30-300 mg/g.

6
(

12 )

(./.)

(Glomerular Filtration Rate; GFR)

?
GFR

CKD-EPI (estimated
GFR;eGFR) 100 .
( 100%)

(
< 18 )

l


(GFR)
l eGFR

l
eGFR


l eGFR


GFR 60 .//1.73
3
1
1.

1
2
3
4
5

* GFR

* GFR

GFR
GFR

eGFR (.//1.73
)
> 90
60 89
30 59
15 29
< 15 (
)

eGFR > 60 .
-


eGFR < 60 .
- eGFR

-
(NSAIDs)
ACEIs/ARBs
-



(urine protein
creatininie ratio, UPCR)

 -



-


-

eGFR 5

1 3

-
UPCR>1,000 ./
proteinuria 4+

3

10

 -

-

-

-

-
-

-

-

IVP

>30% eGFR
> 25% ACEIs/ARBs
GFR > 0.5 .//
1.73 /

SLE, ,
multiple myeloma

(>150/90
3 )

11

 4 5

-
-
- (
ACEIs/ARBs)
-

-
/
- /
()

12

 -


-

CBC, eGFR
, BUN, , , , HbA1c

()

-
( 2)
2.

1 2 , eGFR, UPCR*

, eGFR, UPCR* 6 (12

3
Hb, potassium, calcium, phos- **)
phate
4 5 , eGFR, UPCR* 3 (6
Hb, potassium, calcium, phos- * * 4)
phate, bicarbonate, PTH

UPCR*
** eGFR < 2 ./ 6

13

 -


- :
50
60


albuminuria

l BP<150/90 mmHg
l LDL
100 ./.
-
l 140/90 mmHg
130/80 mmHg
l ACEs/ARBs

14

 i

u
u 2
u
i >30% GFR
> 25%

- (HbA1c)
7
- > 6 mmol/l
l

l NSAIDs
l
l ACEs/ARBs

15

 3:

- <10 g/dl

l
ESA 200 500 mcg/l 10-12 g/dl
-
l
l
l eGFR
-
-
l
l NSAIDs

16

 4-5:

-

-
- parathyroid hormone
-
-

-
-

(www.nephrothai.org)

17


1. Domrongkitchaiporn S, Sritara P, Kitiyakara C,
Stitchantrakul W, Krittaphol V, Lolekha P, et al. Risk
factors for development of decreased kidney function
in a southeast Asian population: a 12-year cohort
study. J Am Soc Nephrol2005 Mar;16(3):791-9.
2. Chittinandana A, Chailimpamontree W, Chaloeiphap P. Prevalence of chronic kidney disease in Thai
adult population. J Med Assoc Thai2006 Aug;89 Suppl
2:S112-20.
3. Ong-Ajyooth L, Vareesangthip K, Khonputsa
P, Aekplakorn W. Prevalence of chronic kidney disease
in Thai adults: a national health survey. BMC
Nephrol2009;10:35.
4. Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, et al. Prevalence
and risk factors of chronic kidney disease in the Thai
adult population: Thai SEEK study. Nephrol Dial Transplant
May;25(5):1567-75.

18

5. Perkovic V, Cass A, Patel AA, Suriyawongpaisal

P, Barzi F, Chadban S, et al. High prevalence of
chronic kidney disease in Thailand. Kidney Int2008
Feb;73(4):473-9.

19