335.2 🩺 國考版

335.2.1 高頻考點

335.2.1.1 CKD Definition

  • eGFR < 60 OR kidney damage ≥ 3 mo

335.2.1.2 KDIGO Staging

  • G1-G5 by eGFR (90+, 60-89, 45-59, 30-44, 15-29, < 15 or RRT)
  • A1-A3 by UACR (< 30, 30-300, > 300 mg/g)

335.2.1.3 Top CKD Causes

  • DM (DKD) #1
  • HTN
  • GN (IgA, FSGS, lupus)
  • PKD
  • Tubulointerstitial

335.2.1.4 Complications

  • CV (top death cause)
  • Anemia (EPO + iron deficiency)
  • CKD-MBD (hyperphosphatemia + 2° hyperPTH)
  • Electrolytes (hyperK, acidosis)
  • Uremia
  • Protein-energy wasting

335.2.1.5 CKD-MBD

  • ↑ Phosphate
  • ↓ Calcitriol (1α-hydroxylase deficient)
  • ↑ PTH (secondary)
  • ↑ FGF-23 (early marker)
  • Vascular calcification

335.2.1.6 CKD-MBD Treatment

  • Phosphate binders (Ca-based or non-Ca)
  • Active vitamin D (calcitriol, paricalcitol)
  • Cinacalcet for severe 2° hyperPTH
  • Etelcalcetide (parenteral)
  • Parathyroidectomy refractory
  • Avoid excess Ca

335.2.1.7 Renal Anemia Management

  • Iron first
  • ESA (epoetin) — target Hgb 10-11.5 (CHOIR, TREAT — caution higher)
  • HIF-PHI (roxadustat, vadadustat, daprodustat) — NEW

335.2.1.8 HIF-PHI Approval

  • Roxadustat (Evrenzo)
  • Vadadustat (Vafseo)
  • Daprodustat (Jesduvroq, FDA 2023)
  • Oral
  • Stabilize HIF → endogenous EPO

335.2.1.9 Hypertension in CKD

  • Target < 130/80 (KDIGO 2021)
  • ACE/ARB first-line (proteinuria)
  • Often resistant (multi-drug)

335.2.1.10 Acidosis in CKD

  • Metabolic acidosis with anion gap
  • Sodium bicarbonate (target HCO3 22-26)

335.2.1.11 CV Risk in CKD

  • CHD risk equivalent
  • Statin for primary prevention if eGFR < 60 + albuminuria

335.2.1.12 Bleeding

  • Platelet dysfunction
  • DDAVP, cryoprecipitate for severe

335.2.2 易混淆比范

Stage eGFR Complications Action
G1-G2 ≥ 60 None typically RF control
G3a 45-59 Anemia start, MBD start Monitor + slow progression
G3b 30-44 More marked Refer nephrology
G4 15-29 Marked CKD-MBD, anemia, uremia Prepare RRT
G5 < 15 Severe; uremia RRT or transplant

335.2.3 Special Topics

335.2.3.1 Sclerosis-Hyperfiltration Cycle

  • Loss of nephrons → hyperfiltration in remaining
  • Maladaptive
  • ACE/ARB break this cycle
  • SGLT2i also reduce hyperfiltration

335.2.3.2 Diabetic Kidney Disease (DKD) Specifics

  • Microalbuminuria first sign
  • Eventually macroalbuminuria
  • Nephrotic-range possible
  • Treatment: SGLT2i + ACE/ARB + finerenone + GLP-1

335.2.3.3 Hypertensive Nephropathy

  • Progressive sclerosis
  • Often with small kidneys
  • ACE/ARB
  • BP target < 130/80