( e-learning ) ( e-learning ) 20%( ) (Chronic Kidney Disease, CKD) Stage 123a 1.CKD stage 1 (estimated Glomerular filtration rate, egfr)90 ml/min/1.73 m 2 (Urine Protein and Creatinine Ratio U PCR ) 150 mg/gm ( U ACR 30 mg/gm) 2.CKD stage 2 egfr 60~89.9 ml/min/1.73 m 2 U PCR 150 mg/gm ( U ACR 30 mg/gm) 3.CKD stage 3aeGFR 45~59.9 ml/min/1.73 m 2 1. 2. 3. ( 8.3.4) 1. Urine protein/creatinine ratio (UPCR) 1000 mg/gm egfr45 ml/min/1.73 m2 (Pre-ESRD)(Stage 3b ) 2. 3.(180 ) - 1 -
1. (1) K-DOQI(Kidney Disease Outcomes Quality Initiative) Guideline( http://www.kidney.org/professionals/kdoqi/guidelines.cfm) (2)() /) 8.3.1 2. 3. ( 8.3.6)(Pre-ESRD) 1. (1)CKD stage 2 stage 1 (2)eGFR (egfr) 2. (1)130/80 mmhg (2)(HbA1c)7.0% (3)(LDL)130 mg/dl (4) (VPN)( 8.3.2) ( 8.3.38.3.4 8.3.5)( ) () 1. 2. (1) P4301CP4302CP4303C E1 ()EB (2) - 2 -
50% 1. 2. (1)(P4301C)(P4302C) (2)(P4301C) a.(p4302c) b.(p4302c) 1.CKD stage 2 stage 1 2.eGFR (egfr) 2 (1)140/90 mmhg 130/80 mmhg (2) HbA1c 7.0%7.0% (3)(LDL)130 mg/dl 130 mg/dl (4)() 1 2 400 P4301CP4302CP4303C 1 1 ( ) - 3 -
P4301C (8.3.3) (8.3.4) v v v v 200 P4302C 1.(8.3.4) 2. P4303C 1. (Pre-ESRD) 2.(8.3.6 )( ) (Pre-ESRD ) 3.(180 ) v v v v 200 v v v v 200-4 -
8.3.1 (egfr) Stage 1 Stage 2 90 ml/min/1.73m² 60-89.9 ml/min/1.73m² Stage 3 a b 30-59.9 ml/min/1.73m² 45-59.9 ml/min/1.73m 2 30-44.9 ml/min/1.73m 2 Stage 4 15-29.9 ml/min/1.73m² Stage 5 <15 ml/min/1.73m² :1.(CKD) 2.()() 1.(U PCR U ACR ) 2.: (A) (B) (C) (D) (E) (F)( SLE) (G) (H) (I)>60 5
P4301C 1 200 egfr45 ml/min/1.73 Upcr150mg/gm egfr45ml/min/1.73 1.Urine Protein 2.Urine creatinine 3.Serum creatinine 4.LDL 5.HbA1c(%)DM CKD Stage 1-3a CKD Stage 3b-5 1. 2.CKD ) Pre-ESRD CKD ) * Urine protein / creatinine ratio Upcr1000 mg /gm * egfr < 45 ml/min /1.73 P4302C 1 200 P4303C 1 200 Upcr1000 mg /gm egfr < 45 ml/min /1.73 Pre-ESRD 2. 180 CKD ) Stage 1-3a CKD stage1 egfr 90ml/min/1.73 + Upcr150mg/gm( Uacr30mg/gm) CKD stage2 egfr 60~89.9ml/min/1.73 + Upcr150mg/gm( Uacr30mg/gm) CKD stage3a egfr 45~59.9ml/min/1.73 6
Stage 1 egfr90 ml/min/1.73 m 2 Stage 2 egfr60~89.9 ml/min/1.73 m 2 Stage 3aeGFR45~59.9ml/min/1.73 m 2 Stage 3beGFR30~44.9 ml/min/1.73 m 2 (U PCR 2,000 mg/gm ) BMI 1. 2. 3. 4. 5.() 6.(U PCR 2,000 mg/gm ) 7. 8. 9. 10.() 7
8.3.2 ( ID): 1.CKD Stage1Stage12Stage23aStage3a (1.2.3.4.5.6.7. 8.9.)1. 2. 2.eGFRU PCR (mg/gm) 3.Serum creatinine(mg/dl)ldl (mg/dl)hba1cdm ( ID) : 1.CKD Stage1Stage12Stage23aStage3a3bStage3b4 Stage45Stage51. 2. 2.eGFRU PCR (mg/gm) 3.Serum creatinine(mg/dl)ldl (mg/dl)hba1cdm ( ID) : 1. 2.1(Pre-ESRD) 23(180)456 3.Pre-ESRD1U PCR 1000 mg/gm3bstage3b4stage 45 Stage 5 4. 8
8.3.3 P4301C 1. 2. ( ) ( ).. 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 6. 7. 8. 9. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. A. B. C. D. E. F. G. 1. 18. 2. 19. 3. 20. 4. 21. 5. 22. 6. 23. 7. 24. 8. 25. 9. 26. 10. 27. 11. 28. 12. 29. 13. 30. 14. 31. 15. 32. 16. 33. 17. 34. 35. 9
1.(130/85 ) 2. 3.(TG>150) 4. 5.(AC>100) 6.(BMI) 7. 1. 2. / 3. 1. 2. 6. 3. 4. 5. CC 1. 2. 3. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1. a.b. 2. a.b. 3. a. b. 4. 30 a. b. 5. a. b. c. d. e. 10
8.3.4 P4301CP4302C (mmhg) (cm) (kg) (cm) () (cm) () BMI () () 1. 2. Urine PCR(mg/gm) Urine ACR(mg/gm) () Uric acid (mg/dl) () Serum creatinine (mg/dl) egfr(mdrd) CHOL (mg/dl) () LDL (mg/dl) HbA1 C (%)DM Sugar AC (3M) NSAID (mg/dl)dm ACEI ARB CCB DRI ACEI ARB CCB DRI ACEI ARB CCB DRI ACEI ARB CCB DRI 11
8.3.5 1. CKD Pre-ESRD ID Urine protein/creatinine ratio (U PCR )1000 mg/gm 30 ml/min/1.73 m 2 egfr45 ml/min/1.73 m 2 (Stage3b) 15 ml/min/1.73 m 2 egfr30 ml/min/1.73 m 2 (Stage 4) egfr15 ml/min/1.73 m 2 (Stage 5) 2. 3.(180 ) 4. 5. 6. 12
(()) 8.3.6 ()( )() () A.() D. B. ICD-10-CM 1.() 2. 3. C. 1. 2. 1. 4. 2. 5. 3. 6. () () 1. 2. 3. 4. 5. 1. 2. 3. ICD-10-CM 13
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