55.3 🩺 內科專科考前版

55.3.0.1 📌 䞀頁重點

  • 22E: novel biomarkers (NGAL, KIM-1, TIMP-2/IGFBP-7), continuous KRT, Earlier RRT trial
  • HRS-AKI new criteria + terlipressin
  • Taiwan: HBV/HCV cirrhosis, dialysis prevalence 高

55.3.0.2 💊 進階

55.3.0.2.1 AKI Biomarkers
  • NGAL (neutrophil gelatinase-associated lipocalin)
  • KIM-1
  • TIMP-2 × IGFBP-7 (NephroCheck)
  • 早期 detect tubular injury
55.3.0.2.2 CKD Staging
  • GFR-based: G1 (≥ 90) 
 G5 (< 15)
  • Albuminuria: A1 (< 30), A2 (30-300), A3 (> 300)
  • KDIGO 6 categories
55.3.0.2.3 Renal Replacement Therapy
  • IHD (intermittent HD)
  • CRRT (CVVH, CVVHD, CVVHDF) — for unstable
  • SLED (sustained low-efficiency)
  • PD (peritoneal)
55.3.0.2.4 HRS-AKI
  • New diagnostic criteria
  • Terlipressin + albumin
  • TIPS / transplant
55.3.0.2.5 Specific GN
  • IgA: tonsillectomy + ACEI; rituximab refractory
  • MN: rituximab if PLA2R + (vs. tacrolimus)
  • Lupus nephritis: induction MMF / cyclophosphamide; voclosporin / belimumab
  • ANCA: rituximab > cyclophosphamide for induction

55.3.0.3 🌟 Pearls (10)

  1. NephroCheck for early AKI in ICU
  2. Earlier RRT trials: AKIKI, IDEAL-ICU, STARRT-AKI
  3. HRS-AKI terlipressin US approved
  4. Voclosporin / belimumab for lupus nephritis (22E)
  5. Aristolochic acid nephropathy in Taiwan / Asia
  6. CIN incidence overestimated (recent trials)
  7. Sodium bicarbonate vs saline for CIN prevention same
  8. DLQ / albumin in HRS, hepatorenal
  9. Hyper-acute rejection vs ATN in transplant
  10. Crescentic GN rapid progression → urgent biopsy + immunosuppression

55.3.0.4 📍 Taiwan Context

  • Dialysis incidence/prevalence 党球前列
  • HBV/HCV cirrhosis multiple → HRS
  • Aristolochic acid nephropathy 䞭草藥
  • 健保 dialysis
  • Renal transplant limited supply

55.3.0.5 🎓 內專重點

  1. AKI 䞉分法 + workup
  2. Glomerular disease specific (新藥)
  3. Dialysis indications
  4. HRS terlipressin
  5. CIN prevention

⚠ AI 草皿。