“ 開業医の現場で広く網をかけてスクリーニングすることで患者さんの状態をいち早く把握 “
気軽にできる尿中アルブミン定性検査は、糖尿病患者に限らず高血圧患者の動脈関連疾患の合併症を早期発見するためのスクリーニング用ツールとして、また、患者さんに納得して治療を受けていただくためのコミュニケーション用ツールとしても役に立っています。
開業医の現場で広く網をかけてスクリーニングすることで、患者さんの状態をいち早く把握できることが大切であると考えています。
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地域密着型の竹ノ塚診療所では、糖尿病や高血圧患者様の治療や経過観察の指標として尿検査を活用されています。尿検査全般と尿中アルブミン測定についてお話をうかがいました。
“ 開業医の現場で広く網をかけてスクリーニングすることで患者さんの状態をいち早く把握 “
気軽にできる尿中アルブミン定性検査は、糖尿病患者に限らず高血圧患者の動脈関連疾患の合併症を早期発見するためのスクリーニング用ツールとして、また、患者さんに納得して治療を受けていただくためのコミュニケーション用ツールとしても役に立っています。
開業医の現場で広く網をかけてスクリーニングすることで、患者さんの状態をいち早く把握できることが大切であると考えています。
高血圧、高脂血症、糖尿病、消化器疾患の方が主に来院され、うち糖尿病、高血圧、高脂血症の割合は6割ほど。
尿検査は治療効果判定も同日にできる点が長所です。当院ではこれまで、尿検査としては定性・沈渣のほかに1日塩分摂取量の概算を外注検査で行い、患者さんの生活指導をしていました。
この検査は定性試験のため糖尿病患者に限らず広く検査を施行することができます。CKDが注目される中、高血圧の患者さんに対しても早期に腎障害の合併の有無が気軽に確認できるため本装置を導入しました。つまり動脈硬化関連疾患の合併症を早期に指摘するためのスクリーニング検査としての位置づけとなります。
当診療所は高齢者の受診も多いため、年々増加傾向を認め人工透析導入の原因の約12%を占める腎硬化症に対し早期に治療を開始するためにも有効と考えています。微量アルブミン尿陽性の時点で早期に治療の開始・薬剤変更を行うことで検査結果を改善することも可能になります。
ステータス プラスを導入してからは受診の待ち時間ですぐ測定できるのはもちろん、後から届いた検体でもすぐに測定できるため患者さんにはさらに気軽に尿検査を受けていただけるようになりました。小型で場所を取らないことと、医療装置としては低価格であり非常に導入しやすかったです。
ミクロアルブ・クレアチニンテストは随時尿でもアルブミンをクレアチニンで補正できるので、測定値の信頼度が高くなっておりその値を治療介入に反映することができています。
自分がイメージしていたより腎障害合併例が多かったことです。つまり血圧の数値が良い症例の中でも診察結果と検査結果に乖離症例があったということです。血圧手帳に記録されている家庭での血圧値が良好でも、適切な測定条件で測定された数値でない場合があるからです。患者さんによっては最低値のみを記録する場合もあり、そのような患者さんに対しても別の指標である尿アルブミン検査で腎障害の合併有無が判断できることが強みとなります。
【インタビュー内容】
など
【お話をおうかがいした先生】
医療法人社団 医眞会 竹ノ塚診療所
小川 眞広 医師
山本 義信 医師
田辺 千恵子検査技師
【医療法人社団 医眞会 竹ノ塚診療所 診療理念】
先代が開業してから40年間、地域に根ざした医療を理念としています。
7~8年前に改築を行いバリアフリー化の実現とともに待合室の天井を高くし圧迫感のない広い空間にしています。駅からも近くて通いやすくまた従業員同士も仲良く、なんでも相談できるような親しみやすい院内づくりを心がけています。
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