From Dr Daniel Lin, Renal Physician, CMDHB

Prevention and Management of Chronic Kidney Disease慢性腎臟病的預防與治療

什麼是腎臟跟它的功能？
What are kidneys and what do they do?

腎臟是人體中必要的器官，正常成人具備兩枚腎臟，位於腰部兩側後方。供給腎臟的血流主要來自腹腔主動脈和向左右各分一支的腎動脈。
Kidneys are essential organ situated at your loin, one on each side. They are connected by blood vessels to your main artery inside your abdomen.

腎臟的主要功能為過濾血液中的雜質、多餘體液，最終產生尿液排出體外。同時也俱備平衡功能，調節體內電解質濃度、酸鹼平衡、跟血壓。
They are acting as filtering machines to clean up your blood and get rid of toxins, wastes, and extra water in a form of urine. They are also acting as balancing machines in your body to adjust electrolytes, acid-base balance, and blood pressure.

腎臟也兼具內分泌的功能，其中包括維生素D和紅血球生成素，來維持和調節骨骼健康和骨髓中紅血球的生成。
They are also acting as hormone releasing organ forming vitamin D and erythropoietin important in your bone metabolism and promoting blood cells generation in bone marrow.

慢性腎臟病是什麼？如果腎臟功能失常會有什麼症狀？
What is chronic kidney disease and what happens when kidneys are not functioning well?

慢性腎臟病 / 慢性腎衰竭 (Chronic kidney disease 簡稱 CKD) 是種長期腎臟功能損壞，通常由多次性重複且無法恢復的傷害所引起的。這是一種所謂的「進行性」慢性疾病，從一開始的輕微腎衰竭進入到嚴重末期腎臟疾病可能需要五至十年的病程。慢性腎臟病根據腎過濾血液功能分為五期。
Chronic kidney disease happens when there are damages to the kidneys caused by various insults, normally with repetitive and persistent injuries. This process can start early but normally progress slowly, and it can take up to 5-10 years to progress from mild to severe disease. There are 5 stages of chronic kidney disease depending on the severity and the ability of the kidneys filtering or cleaning your blood.

根據不同影響腎功能的危險因子，大部份的時候一旦腎臟受到傷害，是無法完全痊癒和恢復之前的功能。
Depending on the causes, once the kidneys are damaged, unfortunately most of them will not recover back to their original state.

當腎臟損壞時，它會失去原有的機能包括過濾血液雜質、調解平衡功能、和產生分泌激素。腎功能失常會造成一些症狀，例如水腫、倦怠、食慾不振、噁心嘔吐、體重下降，嚴重時則是昏迷跟死亡。但是，當這些症狀出現時，疾病本身已經進行了一段時期，通常至第三或四期腎臟病以上才會出現。所以慢性腎臟病是種隱形殺手。慢性腎臟病患者死亡率比沒罹患腎臟病的一般人還高，而主要的死亡原因是心血管疾病。
When the kidneys are not functioning well, obviously they will lose their jobs as a cleaner, balancer, and hormone producer. Symptoms will developed such as swelling, lethargy, reduced appetite, nausea and vomiting, weight loss, and in severe cases, coma or death. However, these symptoms normally do not appear until the kidneys have reached at least stage 3 or 4 disease. Therefore, CKD is considered to be a silent killer. CKD is associated with increased morbidity and mortality (mainly from cardiovascular disease) when compared to healthy individuals.

以下為慢性腎臟病分期合症狀

哪些是造成慢性腎臟病的病因跟危險因子？
What cause chronic kidney disease and what are the risk factors?

糖尿病跟高血壓是主要造成慢性腎臟病的頭號危險因子，其次是肥胖症、藥物、發炎性疾病跟任何腎臟尿道阻塞性疾病。一些先天性疾病也會導致慢性腎臟病，可是這一般比較少見。
Diabetes and hypertension are the leading causes of CKD among our population, followed by obesity, medication use and disease causing inflammation or obstruction of kidneys. They can also be caused by congenital conditions, although they are relatively rare.

造成慢性腎臟病的危險因子為：
Other risk factors to develop CKD including the following:

• 高血壓 Hypertension
• 糖尿病 Type 2 DM
• 痛風病史 Gout
• 濫用藥物 Medication overuse
• 肥胖症 Obesity
• 吸煙 Smoking
• 60歲以上 Age 60+
• 有家族病史 Family history
• 社經地位偏低 Low socioeconomic status

有這些危險因子將會提高 20-40% 罹患慢性腎臟病的風險。所以建議有以上病因的民眾，需要篩檢和長期追蹤監控腎臟功能，例如每半年到一年由您的家庭醫師安排尿液檢驗跟抽血檢查。
These factors are associated with 20-40% increased risk in developing CKD, and people with above risk factors are recommended to have screening and monitoring of their kidney function by doctors. Tests done by GP include urine and blood tests annual or biannually.

慢性腎臟病的預防
How to prevent CKD from happening?

2013 澳亞腎臟病指導守則 (CARI Guideline 2013)

此外，還需要避免使用非類固醇消炎藥，來路不明的草藥 （尤其含有重金屬汙染的中藥）。保持足夠的水分攝取也是預防慢性腎臟病的發法之一。
Furthermore, avoiding non steroidal anti inflammatory drugs, unknown herbal medicines ( esp heavy metal containing Chinese Herbal medicine), and adequate oral fluid intake are also important in our population to prevent CKD.

如果我檢查出有慢性腎臟病怎麼辦？
What happens if I am diagnosed with CKD?

通常一旦腎臟受到長期損害，這些腎功能傷害是永久的也無法完全恢復。慢性腎臟病治療的主要目標是阻止及減緩病情向腎衰竭末期發展。
When kidneys are damaged especially over long period of time, the full recovery is unlikely. However, focus of management is on the prevention of further deterioration and/or slowing down the rate of progression to more advanced stage of CKD.

其中治療方法有：
These strategies include:

一些降血壓藥物在臨床實驗中已被證實能減緩腎功能下降速度，例如血管緊張素轉化酵素抑制劑 (ACE inhibitors) 及血管緊張素II受體對抗劑 (Angiotensin II Receptor Blockers)。您的家庭醫師會在仔細衡量病因跟病症後下藥。
There are medications, such as ACE inhibitors or Angiotensin II Receptor Blockers, proven to have effect of slowing down progression of CKD. Your family doctor will evaluate your situations before starting on these medications.

一旦被證實罹患慢性腎臟病後，根據不同病因，每 3-6個月定期的尿液跟抽血檢驗是至關重要的。如果你的慢性腎臟病已達到第四期以上，或你開始有症狀，你將會被轉診至腎臟內科進行更深一步的檢查，病情監控跟治療。
Once you are diagnosed with CKD, it is crucial to see your GP regularly with blood and urine tests every 3-6 months depending on the cause and the severity of your CKD. If CKD has progressed to stage 4 or more, or you have developed symptoms, or there are abnormalities in your urine or blood tests, you will be referred to kidney department in Hospital of your area for further investigation, monitoring, and management.

如果我已達到第五期或末期腎衰竭代表什麼?
What happen when I reach stage 5 or end stage CKD?

這表示您已失去您所有的腎臟功能，通常這時候身體會感到很不舒服。在還沒開始腎臟替代療法時的死亡率很高。目前替代腎功能的治療方法有人工透析 (dialysis) 跟腎臟移植 (kidney transplant)。雖然人工透析跟腎臟移植可以替代腎功能，這兩種治療方法通常也有連帶的危險性和問題，所以最好的治療方式還是預防慢性腎臟病的產生！
This means that your kidneys are close to shut down completely. People are normally feeling very sick and doomed when they reach this stage. The risk of death is very high, if treatments to replace the loss of kidney function have not yet started. Treatments to replace the loss of kidney functions include dialysis and kidney transplant. Although dialysis and kidney transplant are effective ways to replace kidney functions and keep patients alive, they are also associated with their own complications and problems. Therefore, the best options is to prevent patients from developing advanced CKD.