Diagnosis and treatment of elderly patients with chronic kidney disease - diagnosis and differential diagnosis

A diagnosis of ideas
(1) CKD existence and determine the degree of renal impairment ( staging )
According to the definition of CKD , kidney function and related auxiliary examination to confirm the presence and staging of CKD .
For single eGFR <45 ~ 60ml/min.1.73m2 the elderly should be excluded after vascular diseases ( hypertension, atherosclerosis , arteriosclerosis, kidney caused CKD. EGFR observe dynamic changes , such as the rate of decline in eGFR 1 about ml/min.1.73m2, there may be physiological glomerular function decline in elderly should not be diagnosed with CKD.
( 2 ) diagnosis of the cause
Find the primary disease caused by CKD . By the late onset , although the former is more difficult to determine , but there is a need , if they can alleviate some of the primary disease , often making slow progress of the disease . In younger patients , CRF cause mostly only one, and the elderly CKD patients, the cause may be more than one , such as hypertension, renal atherosclerosis often coexist with diabetic nephropathy , renal arteriosclerosis and chronic kidney disease or chronic renal interstitial glomerulonephritis , etc. exist , there is a CKD patients with acute kidney injury (AKI) converted from .
( 3 ) whether there are risk factors for acute exacerbations ,
Find and remove the aggravation of CRF reversible factors , so that the condition can be alleviated, delaying the progression of CRF .
( 4 ) diagnosis of complications
The most common is renal hypertension, renal anemia , metabolic acidosis , renal osteodystrophy , there are other acute left ventricular failure , uremic cardiomyopathy, uremic lung disease, uremic encephalopathy, uremic peripheral nerve disease and infection , and bleeding.
2 Differential diagnosis : first with the identification of AKI , especially past history is not clear who , AKI kidneys or increase the size of the patient as usual , anemia obvious and so can be identified. Second, we must distinguish between the progress of chronic renal insufficiency or the acute changes . Some are very difficult to judge the performance of patients with uremia syndrome ( eg rapidly progressive nephritic syndrome ) , in strictly indications and under close observation renal biopsy can be judged , in order to avoid mistakes which led to the diagnosis of diseases of the timing of the loss .