만성 신질환의 평가와 분류 Ⅰ. 만성 신질환의 정의와 단계
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1. 정의: 신 손상의 증거가 있거나 사구체 여과율이 60mg/min/1.73m²미만
으로 감소한 상태가 3개월 이상 지속되는 상태를 의미합니다.
① 신손상: 현재 사구체 여과율 수준에 관계가 없이, 향후 사구여과율을
감소시킬 수 있는 구조적 또는 기능적 신이상 소으로 정의하
며 신손상의 증거는 병리학적 이상 또는 혈액이 소변구성
성분의 변화, 또는 영상 검사 이상소견으로 확인 가능합니다
☎ 신손상자: 신손상이 있더라도 사구체 여과율은 정상 이상 유지할
수 있지만 결국 신기능 이상과 심혈관계질환이생길 수
있으므로 사구체 여과율에 관계없이 만성 신질환 해당됩
니다.
신부전: 사구체 여과율(GFR)이 15mg/min/1.73m²미만이거나
사구체 여과율저하네 의한 합병증 치료를 위해 신대체
요법이 필요한 경우입니다. GFR이 15mg/min/1.73m²이상
에서도 요독증 증상으로 투석이나 이식이 필요한 경우도
있습니다.
② 신이식 수여자: 사구체 여과율이나 신손상의 증거와 상관없이만성
신질환으로 정의합니다.
2. 만성신장질환은 추정사구체 여과율(eGFR)로 대변되는 신기능에 따라
5단계로 분류됩니다.
|
단 계 |
서술 |
GFR (ml/min/1.73m²) |
세 부 사 항 |
조치 |
|
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> |
만성 신질환 위험군 |
≥60 (만성 신질 환 위험인 자 동반) |
GFR 60은 정상 성인 사구체여과율의 50%이상이 감소되었음을 의미 |
▪ 검진 ▪ 위험인자 치료 |
|
1 |
신손상: 정상 또는 증가된 사구체 여과율 |
≥90 |
단백뇨, 혈뇨 또는 신장의 조직학적변화 |
진단, 치료 동반질환치료, 진행속도완화, 심혈관 위험인자 치료 |
|
2 |
신손상: 경도의 사구체여과율 감소 |
60-89 |
▪ 다른 신손상의 증거가 있는 경우 만성신질환으로 진단 ▪ 범위 내이나 신손상의 증거가 없는 경우: 영아나 노인에서 매우 흔하며 그 나이에서는 정상수준으로 간주함 ▪ 기타원인: 채식주의, 한쪽신 장절제, 심부전, 간경화와 같 이 신혈류량이 감소시키는 전신질환 등 |
진행속도 평가 |
|
3 |
중등도의 사구체 여과율 감소 |
30-59 |
|
합병증 평가와 치료 |
|
4 |
중증의 사구체 여과율 감소 |
15-29 |
|
신대체 요법 준비 |
|
5 |
신부전 |
〈 15 (또는투석) |
|
신대체 요법 |
- 이전글만성 신질환의 평가 및 분류 Ⅱ. 만성 신질환의 검진대상 12.11.25
- 다음글만성콩팥병 예방과 관리를 위한 9대 생활수칙 12.10.24
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