| 特集名 | よりよい透析療法のために -- 保存期腎不全治療の重要性 | |
|---|---|---|
| 題名 | 腎臓専門医と病診連携 | |
| 発刊年月 | 2004年 06月 | |
| 著者 | 伊丹 儀友 | 日鋼記念病院腎センター |
| 著者 | 大平 整爾 | 札幌北クリニック |
| 著者 | 浜田 弘巳 | 日鋼記念病院外科 |
| 著者 | 高田 譲二 | 日鋼記念病院外科 |
| 著者 | 勝木 良雄 | 日鋼記念病院外科 |
| 著者 | 辻 寧重 | 日鋼記念病院外科 |
| 著者 | 角田 一真 | 登別記念病院 |
| 【 要旨 】 | 末期慢性腎不全患者が合併症の少ない良好な全身状態で透析療法を継続するためには，かかりつけ医と腎・透析専門医との緊密な連携が必要である．初診医が腎疾患を専門としない場合には，糸球体濾過率 (GFR) が30 ml/minになる時期に患者に腎臓専門医を紹介し，透析方法や移植についての説明を受けさせ，精密検査やアクセス作製に備えることを勧めたい．血清クレアチニン値のみで腎機能を評価すると，高齢者では時としてGFRを過大評価しやすい． 今後，わが国に適合したGFRの推定式の使用や，透析医学会と腎臓学会および糖尿病学会，老年医学会による透析前治療についての合同ガイドラインの作成などが必要である． |
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| Theme | Importance of Preservative Management in Chronic Renal Failure -- for a Better Dialysis | |
|---|---|---|
| Title | Cooperation between hospitals/clinics and nephrologists | |
| Author | Noritomo Itami | Kidney Center, Medical Corporation Caress Alliance, Nikko Memorial Hospital |
| Author | Seiji Ohira | Sapporo Kita Clinic |
| Author | Hiromi Hamada | Department of Surgery, Medical Corporation Caress Alliance, Nikko Memorial Hospital |
| Author | Joji Takada | Department of Surgery, Medical Corporation Caress Alliance, Nikko Memorial Hospital |
| Author | Yoshio Katsuki | Department of Surgery, Medical Corporation Caress Alliance, Nikko Memorial Hospital |
| Author | Yasushige Tsuji | Department of Surgery, Medical Corporation Caress Alliance, Nikko Memorial Hospital |
| Author | Kazumasa Tsunoda | Medical Corporation Caress Alliance, Noboribetsu Memorial Hospital |
| [ Summary ] | Close cooperation between general physicians and nephrologists is necessary in order for chronic end stage renal failure patients to continue dialysis therapy in good condition with few complications. It is recommended that, in cases in which the physician is unfamiliar with renal diseases, where the glomerular filtration rate (GFR) becomes 30 ml/min, the patient should be referred to a specialist. Patients should receive information regarding dialysis methods and transplantation, also thorough testing and preparation for access should be performed. If kidney functions are evaluated by serum creatinine levels only, in elderly patients and at various times, GFR is easily overestimated. In the future, in Japan, the utilization of an appropriate method of estimating GRF and the construction of joint guidelines regarding pre-dialysis treatment with input from representatives of the societies of dialysis physicians, nephrologists, diabetes and geriatrics is necessary. |
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