慢性肾病

包括钠、钾、氯、碳酸氢盐、尿素、肌酐和葡萄糖

仅凭血清肌酐不足以确诊 CKD，在低肌肉质量人群（如老年人、营养不良人群）或肝衰竭患者中可能出现假性偏低

男性正常肌酐值为 70-120 μmol/L（0.8-1.4 mg/dL），女性正常肌酐值为 50-97 μmol/L（0.6-1.1mg/dL）。然而，不同实验室间的不同标定方法导致其差异很大。[3]Webster AC, Nagler EV, Morton RL, et al. Chronic kidney disease. Lancet. 2017 Mar 25;389(10075):1238-52. http://www.ncbi.nlm.nih.gov/pubmed/27887750?tool=bestpractice.com

电解质紊乱可能表明有导致 CKD 的基础性疾病，例如肾小管疾病。[1]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 Jan;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf 肾脏对酸排泄的适应最初可防止血清碳酸氢盐浓度的下降。但随着 GFR 下降，会出现代谢性酸中毒。[1]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 Jan;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf

血清肌酐升高；电解质紊乱

建议使用基于血清肌酐的 GFR 估算公式进行初始评估

使用 Cockcroft-Gault 公式、MDRD 公式或 CKD-EPI 公式等数学公式评估 GFR 和 CKD 的严重程度并进行 CKD 分期会更为准确。[49]Matsushita K, Mahmoudi BK, Woodward M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA. 2012 May 9;307(18):1941-51. https://jamanetwork.com/journals/jama/fullarticle/1151529 http://www.ncbi.nlm.nih.gov/pubmed/22570462?tool=bestpractice.com

尚未证实这些公式用于 GFR>59 mL/(min·1.73 m²) 的患者是否可靠。[1]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 Jan;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf

<60 mL/min/1.73 m²

在某些特定情况下，当基于血清肌酐的 GFR 估算值不准确时，如在肌肉质量极端的人群（例如，健美运动者、肌肉萎缩疾病患者、老年人或营养不良的人群）中，需进行此检查。[1]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 Jan;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf [50]National Institute for Health and Care Excellence. Chronic kidney disease disease in adults: assessment and management. Jan 2015 [internet publication]. https://www.nice.org.uk/guidance/cg182

肌肉质量下降将导致估算值偏高；肌肉质量增加则导致 GFR 估算值偏低

为了寻找排泄到尿液中的肾脏损伤病理性标志物而进行的筛查试验

血尿和/或蛋白尿

CKD 分类需要基于白蛋白排泄率（albumin excretion rate, AER）或白蛋白与肌酐比值（albumin to creatinine ratio, ACR）进行尿白蛋白定量。[1]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 Jan;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf 尿白蛋白中度升高是发生糖尿病和高血压相关的进行性 CKD 和冠状动脉疾病的一个危险因素。对于糖尿病伴 CKD 的患者，如果经尿液试纸检测未发现蛋白尿证据，应进行尿白蛋白检测。[51]Montañés Bermúdez R, Gràcia García S, Pérez Surribas D, et al. Consensus document. Recommendations on assessing proteinuria during the diagnosis and follow-up of chronic kidney disease. Nefrologia. 2011;31(3):331-45. https://www.revistanefrologia.com/en-consensus-document-recommendations-on-assessing-articulo-X201325141105194X http://www.ncbi.nlm.nih.gov/pubmed/21780317?tool=bestpractice.com

中度升高（AER 30-300 mg/d；ACR 30-300 mg/g）

存在肾脏萎缩时有助于诊断 CKD，也有助于诊断肾盂积水或膀胱潴留等梗阻情况

肾脏体积小；存在梗阻/肾盂积水；肾结石