GGA & GGK

Farmakoterapi
Gagal Ginjal

Wahyu Hendrarti
Chronic Renal Failure [ARF]

Farmakoterapi
Gagal Ginjal Kronik
Chronic Kidney Disease
[CKD]
 Pendahuluan
• The kidney is made up of approximately 2
million nephrons that are responsible for
filtering, reabsorbing and excreting solutes and
water.
• As the number of functioning nephrons declines,
the primary functions of the kidney that are
affected include:
 production and secretion of erythropoietin
 activation of vitamin D
 regulation of fluid & electrolyte balance
 regulation of acid-base balance
PATHOGENESIS OF CRF
 Gagal Ginjal Kronik
 Gagal Ginjal Kronik (CRF): gangguan fungsi
tubuh dimana ginjal sudah tidak mampu
menyaring albumin (protein darah) yang
seharusnya dibuang bersama urin, sehingga
pasien mengalami gangguan metabolisme
protein, lemak, dan karbohidrat.
 Tindakan:
1. Kontrol Tekanan darah.
2. Batasi Asupan Protein
3. Mengelola masa prestadium akhir GG (Pre-ESRD)
4. Mengidentifikasi&Mengobati Hiperparatiroidisme
5. Prosedur Cuci Darah [Hemodialisis] atau Transplantasi
Ginjal
 Key consepts of Chronic
kidney disease [CKD]
❶ Chronic kidney disease is a
progressive disease that eventually
leads to renal failure [end-stage
renal disease → ESRD].
❷ Early detection and treatment of
CKD are fundamental factors in
minimizing morbidity and mortality
associated with CKD.
 Key consepts of Chronic kidney
disease [CKD]
❸ Declining renal function disrupts the
homeostasis of the systems regulated by
the kidney, leading to fluid & electrolyte
imbalances, anemia, & metabolic bone
disease.
❹ Angiotensin-converting enzyme inhibitors
[ACEIs] and angiotensin II receptor
blockers [ARB] decrease protein excretion
and are the drugs of choice for
hypertension in patients with CKD.
 Tindakan
1. Kontrol Tekana darah
[tetap di 120-135/70-80 mmHg ~
ACEI dan ARB relatif lebih aman]
2. Batasi Asupan Protein: As. Amino
sebagai produk pecahan protein akan
kembali diproses menjadi karbohidrat dan
limbahnya berupa nitrogen akan
dieliminasi oleh ginjal sehingga akan
memperberat kerja ginjal serta
mempercepat perburukan CRF →
[0,6 – 0,8 g/KgBB/hari]
Pharmacologic Therapy
 FIGURE 23–2. Hypertension management
algorithm for patients with CKD.

Drug of Efek Samping

Choice ACE-I/ARB
 Key consepts of Chronic kidney
disease [CKD]
❺ The most common complication of CKD is
anemia, which is caused by a decline in
erythropoietin production by the kidneys
and can lead to cardiovascular disease.
❻The goal of anemia management is to
increase hemoglobin levels to greater than
11 g/dL (6.82 mmol/L), which generally
requires a combination of erythropoiesis-
stimulating agents & iron supplements.
 Tindakan
• Mengelola masa prestadium akhir
GG (Pre-ESRD~end-stage renal
disease):
Treatment pra-ESRD harus dimulai
segera setelah GFR turun hingga
<30mL/menit.
• Fokus identifikasi dan terapi anemia
[ginjal tidak mampu menghasilkan
Erythropoetin (EPO)]
 FIGURE 23–3. Guideline for Erythropoietin therapy in the
management of ANEMIA of CKD.
Erythropoietin
therapy
 Guidelines for iron
therapy in the
management of anemia
of CKD.
 Key consepts of Chronic kidney
disease [CKD]
❼ Renal osteodystrophy stems from
disruptions in calcium, phosphorus, and
vitamin D homeostasis through the
interaction with the parathyroid
hormone.
❽ The management of secondary
hyperparathyroidism involves correction
of serum calcium and phosphorus levels,
and decreasing parathyroid hormone
secretion.
 Tindakan
• Mengidentifikasi&Mengobati Hiperparatiroidisme
• P↓ fungsi ginjal berakibal akumulasi fosfat dalam
darah sehingga dpt mengurangi kadar kalsium darah
dan memacu kelenjar paratiroid utk melepaskan PTH.
• PTH kemudian larut dalam jaringan tulang dan
melepaskan kalsium ke dalam darah [siklus
hipertiroidisme sekunder]. Pasien bisa patah tulang,
nyeri otot, gatal2 & komplikasi KV sebagai akibat
penyakit tulang metabolik [Osteodistrofi Ginjal].
• Batasi asupan makanan/minuman tinggi Fosfat
[produk susu, cola]. Pasien disarankan konsumsi
suplemen Vitamin D dosis tinggi [untuk menekan
produksi PTH berlebih]
Pathogenesis of secondary hyperparathyroidism & renal osteodystrophy
 Key consepts of Chronic kidney
disease [CKD]
❾Patient education and planning for dialysis
should begin at stage 4 CKD, before end-
stage renal disease [ESRD] is reached, to
allow for time to establish appropriate
access for dialysis.
❿Dialysis involves the removal of metabolic
waste products by diffusion and
ultrafiltration from the bloodstream across
a semipermeable membrane into an
external dialysate solution.
 Tindakan
• Prosedur Cuci Darah [Hemodialisis] atau
Transplantasi Ginjal:
• Hemodialisis [tindakan pembuangan zat racun
dari darah yang disaring melalui membran
sementara di luar tubuh].
• Peritoneal dialysis [tindakan filtrasi dengan
memanfaatkan membran selaput rongga perut dg
cara memasukkan cairan ke ruang peritoneal dan
dibuang setelah selesai].
• Transplantasi Ginjal [tindakan cangkok ginjal
dgn teknik memasang ginjal dari tubuh pendonor
ke tubuh pasien resipien (pasien)].
Sumber
Terima
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