CKD Tipus UJian

8/10/2019 CKD Tipus UJian

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PENYAKIT GINJAL KRONIK

PGK)/CRONIC KIDNEY DISEASE CKD)

Siswanto030.09.237

Fak. KedokteranUniv. Trisakti


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Definisi

Suatu proses patofisiologis dengan etiologiyang beragam, mengakibatkan penurunan

fungsi ginjal yang progresif, dan pada

umumnya berakhir dengan gagal ginjal.

Gagal ginjal: suatu keadaan klinis yang ditandai

dengan penurunan fungsi ginjal yang

ireversibel, pada suatu derajat yang

memerlukan terapi pengganti ginjal yang tetap,

berupa dialisis atau transplantasi ginjal.


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Anatomi Ginjal

Kapsul renalis

Hilus

Ureter

Vena renalis

Arteri renalis

Korteks renalis

Medulla renalis

Kolumna renalis Pelvis renalis

Kaliks mayor

Kaliks minor


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Fisiologi Ginjal


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FUNCTION OF URINARY SYSTEM

Excretionrefers to the elimination of

metabolic wastes that were cell metabolites;

this is the function of the urinary system.

Kidneys play a role in homeostasis of the

blood by excreting metabolic wastes, and by

maintaining the normal water-salt and acid-

base balances of blood.


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Excretion of Metabolic Wastes

Kidneys excrete nitrogenous wastes,including urea, uric acid, and creatinine.

Ureais a by-product of amino acidmetabolism.

The metabolic breakdown of creatinephosphate in muscles releases creatinine.

Uric acidis produced from breakdown of

nucleotides. Collection of uric acid in joints causes gout.


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Maintenance of Water-Salt Balance

Kidneys maintain the water-salt balanceof thebody which, in turn, regulates blood pressure.

Salts, such as NaCl, in the blood cause osmosis

into the blood; the more salts, the greater theblood volume and also blood pressure.

Kidneys also maintain correct levels of

potassium, bicarbonate, and calcium ions inblood.

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Secretion of Hormones

Kidneys secrete or activate several hormones:1) They secrete the hormone erythropoietinto

stimulate red blood cell production,

2) They activate vitamin D to the hormonecalcitriolneeded for calcium reabsorptionduring digestion, and

3) They release renin, a substance that leads to

the secretion of aldosterone.

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Etiologi

Penyakit ginjal diabetes: DM tipe 1 dan 2

Penyakit ginjal non diabetes: glomerular (autoimun,

infeksi sistemik, obat/toksin, neoplasia), vaskular

(hipertensi, makroangiopati, mikroangiopati),tubulointerstisial (PNK, batu, obstruksi, obat/toksin),

keracunan obat, ginjal polikistik

Penyakit pada transplantasi: rejeksi kronik, transplant

glomerulopathy


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MULTIPLE RISK FACTORS FOR CKD

Clinical factors:

Diabetes

Hypertension

Autoimmune disease

Systemic infections

Exposure to drugs associated

with acute decline in kidney

function

Recovery from acute kidneyfailure

Sosiodemographic factors:

Older age

Family history of kidney

disease

Reduced kidney mass

Racial/ethnic background

Smoking


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Patofisiologi

Penyakit etiologi Pengurangan massa ginjal Maladaptasi

Hipertrofi/sklerosis

struktural dan

fungsional nefron

Penurunan

fungsi nefron

yang progresif

Peningkatan

aktivitas RAA

intrarenal

Hiperfiltrasi

Peningkatan

hiperfiltrasi dan

sklerosis


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Manifestasi Klinis

Sesuai penyakit yang mendasari

Sindrom uremia: lemah, letargi, anoreksia,mual, muntah, nokturia, kelebihan volume

cairan, sesak napas, nokturia, neuropatiperifer, pruritus, perikarditis, kejang-kejang,sampai koma.

Gejala komplikasi: hipertensi, anemia, asidosismetabolik, osteodistrofi renal, gagal jantung,gangguan keseimbangan elektrolit


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Management of Chronic Kidney Disease

Blood glucose control

BP Control

ARBs

ACE Inhibitors

Interventions that delay progression

Reduced Functioning and Well-being

Malnutrition

Osteodystrophy

Anemia

Prevention of Uremic Complications

(GFR < 60 cc/min/1.73 m2)

Cardiovascular Disease

Modifcation of Comorbidity

Pre-emptive Transplantation

Kidney Transplant Evaluation

Timely Dialysis Initiation

Timely Dialysis Access Placement

Choice of Dialysis Modality

Education

An "ESRD Clinic"

Preparation for Renal Replacement Therapy

(GRF < 30 cc/min/1.73m2)

Early Detection of CKD


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EVALUATING PATIENTS AT RISK FOR CKD

Evaluating risk factors and identifying GFR

declines are essential to the prompt and

appropriate management of CKD

GFR or age/weight-sensitive eGFR

Blood pressure

Glucose

Urinalysis

Microalbuminuria/proteinuria


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COMORBIDITIES AND COMPLICATIONS OF CKD

Anemia

Hypertension

Cardiovascular disease

Diabetes

Osteodystrophy

Malnutrition

Metabolic acidosis

Dyslipidemia

Deficits in functioning

and well-being


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EVALUATION OF ANEMIA

Hemoglobin and/or hematocrit

Red-blood-cell indices

Reticulocyte count Iron parameters


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TREATMENT OF ANEMIA

Iron supplementation (IV/PO)

EPO

Erythropoiesis stimulating agents


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CONSEQUENCES OF METABOLICACIDOSIS

Abnormal renal handling of ions

Tubular-phosphate reabsorption

Filtered load of calcium and phosphate Tubular-calcium reabsorption

Increased resorption of bone

Increased muscle catabolism


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TREATMENT OF METABOLIC ACIDOSIS IN CKD

Goal

Serum HCO3-: > 20 mEq/l

pH > 7.35

Agents

Sodium bicarbonate tablets (650 mg = 8 mEq HCO3-)

Sodium citrate (Shohls solution)

Dose of HCO3-:

1,01,5 mEq/kg/day

Dependent upon initial serum HCO3-and degree of renalinsufficiency.


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Rumus pemberian bikarbonat:

Rerata Ru-Bikar x BB x HCO3-

Ru-Bikar = [0,4 + (2,6: [HCO3-]) x BB

HCO3- = HCO3

- targetHCO3- sekarang


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CKD Tipus UJian

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