臨牀透析 Vol.23 No.13(4-1)


特集名 慢性腎臓病 (chronic kidney disease ; CKD) -- 新たな潮流
題名 CKD各段階において各職種が果たす役割 (1) 一般開業医 (GP)
発刊年月 2007年 12月
著者 前田 浩利 前田内科医院
【 要旨 】 開業医が見つけるchronic kidney disease (CKD) の契機には,健診による検尿,患者白身の訴え (尿異常,浮腫),既往歴の聴取,家族歴の聴取などがある.クレアチニン値は正常値の者が多い.尿検査では微量アルブミンから顕性蛋白尿になるにつれ,心血管疾患,腎不全に移行するリスクが高くなることが知られている.自覚症状がないため,リスクファクター (高血圧,糖尿病,痛風,排尿障害,妊娠歴,家族歴など) のある者に対し積極的に尿蛋白,微量アルブミンのcheckを行い,早期発見,治療を行う必要がある.専門医へのコンサルトと治療方針の助言を受けることは,腎機能が正常である時期に適切な治療を受けることにつながる.そこでは,腎臓専門医と病診連携がきちんと行われる必要がある.
Theme Chronic Kidney Disease (CKD) -- A new tide flows around the world
Title Roles of general practitioners in CKD treatment
Author Hirotoshi Maeda Maeda Medical Clinic
[ Summary ] General practitioners (GPs) may detect chronic kidney disease (CKD) by performing urinalysis during health examinations, by investigating symptoms (urinary abnormalities, edema, etc.) reports by patients, or by asking questions about their personal histories and family histories. Creatinine levels are often normal. The risk of progression to cardiovascular disease and renal failure is known to increase as urinary findings change from microalbuminuria to overt proteinuria. Since there are no symptoms, patients with risk factors (hypertension, diabetes mellitus, gout, dysuria, past pregnancies, positive family histories, etc.) should be actively monitored to detect urinary protein or microalbuminuria so that CKD may be identified and treated early. Consultation with specialists about the management of these patients may allow them to maintain appropriate treatment while kidney function remains normal. In this situation, GPs can play important roles in supporting CKD patients by providing vital information to nephrologists.
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