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CKD CKDCKD 22 CKD CKD C2 CKD 62.2%CAKUTCKD

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CKDChronic Kidney Disease CKD CKD CKD CKD CKD CKD CKD

CKD1CKDa

GFR60 mL/min/1.73 m2 3

CKD 2013

2002CKDKDOQIKidney Disease Outcomes Quality Initiative CKDKDOQI clinical practice guidelines for chronic kidney diseaseevaluation, classification, and stratificationb2011KDIGOKidney Dis-ease Improving Global Outcomesglomerular filtration rateGFR CKDc CKDGFR90 mLmin1.73 m2

CKD CKD

CKD2 CKDcongenital anomalies of the kidney and urinary tractCAKUT CKD1 CKD 3 CGA CKD 2013 CKD

7

CKD

CGA CKD GFR CKD 1 aCKDCKDGFR

Cr Cr CreGFReGFR Schwartz Schwartz24 eGFR52 GFR GFR 15 2 2 GFReGFR CKD GFR

CKD611 Cr Cr GFR C22MG C GFR CKD Cr 3 15 CKD1 3 18 CKD 25 4 5 CKD

1

2

3

4

GFRmLmin1.73 m21 GFR 902 GFR 60893 GFR 30594 GFR 15295

8

CKD

32 219

C2

CHIV2

CKDGFR

9

CKD

CKD

32 219

C2

CHIV2

CKDGFR

10

2 3 4 5 35 0.27 0.41 0.81 1.61 68 0.30 0.45 0.89 1.77911 0.30 0.45 0.89 1.77

1 0.31 0.47 0.93 1.85 2 0.33 0.49 0.97 1.93 3 0.37 0.55 1.09 2.17 4 0.41 0.61 1.21 2.41 5 0.46 0.69 1.37 2.73 6 0.46 0.69 1.37 2.73 7 0.50 0.75 1.49 2.97 8 0.54 0.81 1.61 3.21 9 0.55 0.83 1.65 3.2910 0.55 0.83 1.65 3.2911 0.61 0.91 1.81 3.61

Ishikura K, et al. Nephrol Dial Transplant 2013282345-2355

4 3 12 CKDmg/dL

2 3 12mg/dL

2.5 50 97.5 35 0.14 0.20 0.26 68 0.14 0.22 0.31911 0.14 0.22 0.34

1 0.16 0.23 0.32 2 0.17 0.24 0.37 3 0.21 0.27 0.37 4 0.20 0.30 0.40 5 0.25 0.34 0.45 6 0.25 0.34 0.48 7 0.28 0.37 0.49 8 0.29 0.40 0.53 9 0.34 0.41 0.5110 0.30 0.41 0.5711 0.35 0.45 0.58

95% 2.5 97.5

Uemura O, et al. Clin Exp Nephrol 201115694-699

3 12 17mg/dL

2.5 50 97.5

12 0.40 0.40 0.53 0.52 0.61 0.6613 0.42 0.41 0.59 0.53 0.80 0.6914 0.54 0.46 0.65 0.58 0.96 0.7115 0.48 0.47 0.68 0.56 0.93 0.7216 0.62 0.51 0.73 0.59 0.96 0.74

Uemura O, et al. Clin Exp Nephrol 201115694-699

11

CKD

8 3 172mg/L

2.5 50 97.5 35 1.5 1.8 3.2 68 1.4 1.8 2.6911 1.3 1.7 3.3

1 1.4 1.7 3.1 2 1.0 1.5 2.5 3 1.0 1.5 2.3 4 1.1 1.4 2.5 5 1.1 1.4 2.3 6 1.1 1.4 2.3 7 1.0 1.4 2.1 8 1.0 1.4 2.5 9 1.0 1.4 2.110 0.9 1.3 1.911 1.0 1.3 2.312 1.0 1.3 1.813 1.0 1.3 1.814 0.9 1.3 2.015 0.8 1.2 1.816 0.8 1.2 1.8 1.0 1.4 2.3

Ikezumi Y, et al. Clin Exp Nephrol 20131799-105

7 12 17 Cmg/L

2.5 50

97.5

1214 0.71 0.61 0.86 0.74 1.04 0.911516 0.53 0.46 0.75 0.61 0.92 0.85

CKD 2012

6 3 12 Cmg/L

2.5 50

97.5

35 0.88 1.06 1.26 611 0.72 0.98 1.251217 0.72 0.91 1.141823 0.71 0.85 1.04 211 0.61 0.78 0.95

CKD 2012

5 12 19 CKDmg/dL

2 3 4 5

12 0.71 0.70 1.07 1.05 2.13 2.09 4.25 4.1713 0.79 0.71 1.19 1.07 2.37 2.13 4.73 4.2514 0.87 0.78 1.31 1.17 2.61 2.33 5.21 4.6515 0.91 0.75 1.37 1.13 2.73 2.25 5.45 4.4916 0.98 0.79 1.47 1.19 2.93 2.37 5.85 4.7317 0.97 0.74 1.45 1.11 2.89 2.21 5.77 4.4118 0.97 0.74 1.45 1.11 2.89 2.21 5.77 4.41

Ishikura K, et al. Nephrol Dial Transplant 2013282345-23551718 242009

Uemura O, et al. Clin Exp Nephrol. 2013Epub ahead of print

12

Cr Cr CKD

CrGFR Cr GFR

GFR 1/5 2 Cr Cr 0.4 mg/dL 1 0.2 mg/dL 4 0.3 mg/dL8 0.4 mg/dL 0.8 mg/dL 0.6 mg/dL 2 12 Cr6

Crmg/dL 0.30m

Uemura O, et al.Clin Exp Nephrol 201115694-699

Cr 2 3 Cr126 Cr Cr

CKDeGFR %eGFR% Cr/ Cr 100GFRCrCr2345 Cr 4/3248 Cr CKD 4 5 1

GFR Cr eGFRa

eGFRmL/min/1.73m2 194 Crmg/dL-1.094-0.287 0.739

CKD 2013

GFR1976 Schwartz23

Step 2A

1

2

3

13

CKD

Cr Jaff2009 Schwartz GFR4 Schwartz

1 17eGFRmL/min/1.73m2 0.413

m 100 Crmg/dL

Schwartz GJ, et al. J Am Soc Nephrol 200920629-637CKD 2013

GFR5 CKD Cr 2 GFR78

152 19 Htm Cr eGFR

eGFRmL/min/1.73 m2 110.2 Crmg/dL

2.93 Crmg/dLCrmg/dL1.259 Ht5 7.815 Ht4 18.57 Ht3 21.39 Ht2 11.71 Ht 2.6284.536 Ht5 27.16 Ht4 63.47 Ht3 72.43 Ht2 40.06 Ht 8.778

Uemura O, et al. Clin Exp Nephrol 2013Epub ahead of print

22 12

eGFRmL/min/1.73 m2 0.35 m

100 Crmg/dLNagai T, et al. Clin Exp Nephrol 201317877-881

15 CKD HPhttp://www.pckd.jpn.org/ [Excel ] 52 12

eGFRmL/min/1.73 m2 k m

100 Crmg/dL

k

Cr Jaff Jaff Cr Cr0.2

Schwartz GJ, et al. Pediatrics 197658259-263Schwartz GJ, et al. Pediatr Clin North Am 198734571-590CKD 2013

1 0.330.4522 0.45213 0.551322 0.70

0.55

eGFR k

14

C2 C CKD

Step 2A Cr CKD C22MG GFR

C C 1.5 mg/L 3 1.1 mg/L1 0.9 mg/L2 0.8 mg/L 0.7 mg/Ld C 6 7 12d, 9GFR CHIVCKD Cr

22MG2MG 8 10

C GFR C CreGFR CKD C GFR11

eGFRmL/min/1.73 m2 104.1

7.80 Cmg/L18

Uemura O, et al. Clin Exp Nephrol 2013Epub ahead of print

GFRGFR GFR 24Ccr GFR GFR CKD

Step 2B

11

12

2

Step 3

15

CKD

2 a CKD 2013 201355585860

b National Kidney Foundation. KDOQI clinical practice guidelines for chronic kidney diseaseevaluation, classification, and stratification. Am J Kidney Dis. 200239S1266

c KDIGO CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 201331150

d CKD 2012 20125410311189

1 Ishikura K, Uemura O, Ito S, Wada N, Hattori M, Ohashi Y, Hamasaki Y, Tanaka R, Nakanishi K, Kaneko T,

Honda M. Pre-dialysis chronic kidney disease in childrenresults of a nationwide survey in Japan. Nephrol Dial Transplant. 2013 Sep28923452355

2 Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976 Aug582259263

3 Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular fil-tration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987 Jun343571590

4 Schwartz GJ, Muoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009 Mar203629637

5 Uemura O, Honda M, Matsuyama T, Ishikura K, Hataya H, Nagai T, Ikezumi Y, Fujita N, Ito S, Iijima K. Is the new Schwartz equation derived from serum creatinine and body length suitable for evaluation of renal function in Japanese children? Eur J Pediatr. 2012 Sep171914011404

6 Uemura O, Honda M, Matsuyama T, Ishikura K, Hataya H, Yata N, Nagai T, Ikezumi Y, Fujita N, Ito S, Iiji-ma K, Kitagawa T. Age, gender, and body length effects on reference serum creatinine levels determined by an enzymatic method in Japanese childrena multicenter study. Clin Exp Nephrol. 2011 Oct155694699

7 Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, Fujita N, Akioka Y, Kaneko T, Honda M. Creatininebased equations to estimate glomerular filtration rate in Japanese children and adolescents with chronic kidney disease. Clin Exp Nephrol. 2013 Sep 7Epub ahead of print

8 Nagai T, Uemura O, Ishikura K, Ito S, Hataya H, Gotoh Y, Fujita N, Akioka Y, Kaneko T, Honda M. Creatininebased equations to estimate glomerular filtration rate in Japanese children aged between 2 and 11 years old with chronic kidney disease. Clin Exp Nephrol. 2013 Dec176877881

9 Yata N, Uemura O, Honda M, Matsuyama T, Ishikura K, Hataya H, Nagai T, Ikezumi Y, Fujita N, Ito S, Iiji-ma K, Saito M, Kaneko T, Kitagawa T. Reference ranges for serum cystatin C measurements in Japanese children by using 4 automated assays. Clin Exp Nephrol. 2013 Dec176872876

10 Ikezumi Y, Honda M, Matsuyama T, Ishikura K, Hataya H, Yata N, Nagai T, Fujita N, Ito S, Iijima K, Kaneko T, Uemura O. Establishment of a normal reference value for serum 2 microglobulin in Japanese childrenreevaluation of its clinical usefulness. Clin Exp Nephrol. 2013 Feb17199105

11 Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, Fujita N, Akioka Y, Kaneko T, Honda M. Cystatin Cbased equation to estimate glomerular filtration rate in Japanese children and adolescents. Clin Exp Nephrol. 2013 Nov 20Epub ahead of print

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