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我父親現階段每次做血透的時候 血壓會很高,上機和上機前不做的時候 正常,有吃高血壓藥,請問會是什麼原因呢 2019-07-18
宋金輝 南京婦幼保健院北院
可能原因有很多,比如幹體重不合适、透前服用可透析掉的降壓藥、鉀鈉鈣鎂異常、透析液鈉高...等等,一般可以通過調整幹體重、調整降壓藥、糾正電解質紊亂、調整透析液參數等來處理[詳情]
我膜性腎病2期,肌酐70,最近牙龈出血腫痛,牙痛,口苦口氣大,看了口腔科,說我腎病引起的吃的藥太多,沒給開藥,腎病醫生也沒給弄藥,牙很疼,吃點啥藥💊 ?謝謝 2019-07-18
宋金輝 南京婦幼保健院北院
如果是環孢素一類引起的沒有太好辦法,注意牙膏的選用和及時更換牙刷好好刷牙,如果是上火可以請正規大醫院的中醫用點降火藥,如果是牙齒本身如牙跟爛了或齲齒發炎,先抗生素消炎然後口腔科處理[詳情]
女,23歲,有腎衰竭5期,現在做腹透,今天,驗了血清鐵蛋白356.9,正常值是322,這個要怎樣降下去 2019-07-17
宋金輝 南京婦幼保健院北院
透析病人鐵蛋白的要求和常人時不一樣的,三百多ng/ml不算高,[詳情]
醫生專區專業及時,為您量身定制
2017+ERA-EDTAE共識文件透析患者高血壓
In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin–angiotensin–aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient’s comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the
中國腎髒疾病高尿酸血症診治的實踐指南ˆ2017版
随着我國人民生活水平提高和生活方式改變,高尿酸血症的患病率呈逐年上升趨勢,已經成為我國重要的公共衛生問題.腎髒疾病是高尿酸血症的重要病因,而高尿酸血症也是慢性腎髒病(chronic kidney disease,CKD)最常見的并發症之一.高尿酸血症可加重腎髒病的進展和心腦血管并發症的發生,是導緻CKD、心腦血管疾病和代謝性疾病發生與發展的獨立危險因素.目前我國尚缺乏針對腎髒疾病高尿酸血症診治的臨床實踐指南.為此,我們圍繞腎髒疾病高尿酸血症的流行病學、發病機制、診斷與病情評估、治療等内容,制定《中國腎髒疾病高尿酸血症診治的實踐指南(2017版)》,以指導臨床更規範地治療腎髒疾病患者的高尿酸血症。
中華人民共和國衛生行業标準-慢性腎髒病患者膳食指導‰
慢性腎髒病患者膳食指導 1 範圍 本标準規定了慢性腎髒病患者膳食指導原則、能量和營養素推薦攝入量、膳食處方的制定、營養攝入監測與評估。 本标準适用于對慢性腎髒病患者進行膳食指導。 2 術語和定義 下列術語和定義适用于本文件。 2.1 慢性腎髒病 chronic kidney disease;CKD 經腎活檢或檢測腎損傷标志物證實的腎髒損傷或GFR持續<60 mL/(min·1.73m²)≥3個月。腎損傷的指标陽性包括血、尿成分異常或影像學檢查異常。 2.2 慢性腎髒病分期 stage of CKD CKD按照GFR值進行分期,見表1。
2017ISPD建議導管相關感染
Peritoneal dialysis (PD) catheter-related infections are a major predisposing factor to PD-related peritonitis (1–3). The primary objective of preventing and treating catheter-related infections is to prevent peritonitis. Recommendations on the prevention and treatment of catheter-related infections were published previously together with recommendations on PD peritonitis under the auspices of the International Society for Peritoneal Dialysis (ISPD) in 1983 and revised in 1989, 1993, 1996, 2000, 2005, and 2010 (4–9). The present recommendations, however, focus on catheter-related infections, while peritonitis will be covered in a separate guideline. These recommendations are evidence-based where such evidence exists. The bibliography is not intended to be comprehensive. When there are many similar reports on the same area, the committee prefers to refer to the more recent publications. In general, these recommendations follow the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system for classification of the level of evidence and grade of recommendations in clinical guideline reports (10). Within each recommendation, the strength of recommendation is indicated as Level 1 (We recommend), Level2 (We suggest), or Not Graded, and the quality of the supporting evidence is shown as A (high quality), B (moderate quality), C (low quality), or D (very low quality). The recommendations are not meant to be implemented in every situation indiscriminately. Each PD unit should examine its own pattern of infection, causative organisms, and sensitivities and adapt the protocols according to local conditions as necessary. Although many of the general principles presented here could be applied to pediatric patients, we focus on catheter-related infections in adult patients. Clinicians who take care of pediatric PD patients should refer to the latest consensus guideline in this area for detailed treatment regimen and dosage (11).
2017年KDIGO關于慢性腎髒病-礦物質和骨異常ˆCKD-MBD臨床實踐指南的解讀
慢性腎髒病-礦物質和骨異常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的防治是慢性腎髒病(chronic kidney disease,CKD)患者減少心血管疾病風險策略中的重要組成部分。 早在 20 世紀 30 年代,中國學者首次提出了腎性骨病(腎性骨營養不良)的概念。作為腎性骨病的延伸,CKD-MBD 的定義誕生于 2005 年馬德裡舉 行的第一次 CKD-MBD 讨論會上。改善全球腎髒病預後組織(kidney disease:improving global outcomes,KDIGO)于 2009 年頒布了适用于全球的CKD-MBD 的診斷、評估、預防和治療的臨床實踐指南[1]。2013 年後,專家多次開會,對指南中的骨病、鈣磷、維生素 D、PTH 水平和血管鈣化這些熱點進行讨論和指南評估/更新的準備。2016 年新指南草案公布,在全球範圍内廣泛征集意見,并于2017 年 6 月正式對外頒布[2](其下載網址見表 1)。新指南中,12 項推薦被重新評估,而大部分 2009年的指南内容未變。新增推薦的證據主要來自于2 0 0 9 年後至 2 0 1 7 年 2 月數項随機對照試驗(randomized controlled clinical trial,RCT)和 Meta分析結果。本文就 2017 版的新指南與舊版指南的更新部分及依然存在的、值得進一步研究的熱點問題進行解讀
2017+NICE診斷指南š多頻生物電阻抗裝置指導慢性腎病患者進行血液透析時的液體管理‰
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.


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