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Replaced partially by HD
Apa yang terjadi bila fungsi ginjal
rusak berat ?
Uremia (gejala akibat tertahannya zat-zat
toksik dalam tubuh): mual muntah, nafsu
makan turun, gatal, kesadaran turun
Tertahannya garam(Na) dan air
:bengkak,sesak,hipertensi
Keseimbangan asam basa terganggu:
asidosis
Fungsi hormonal terganggu :anemia, kalsium
menurun
Uraemic toxins :
Low MW : urea,creatinine
Middle MW : B2 microglobulin, PTH
High MW : myoglobulin
Glomerulonephritis
Diabetic Nephropathy
Urinary Stones Disease
Hypertension
Analgesic nephropathy
Polycystic Kidney
Definition of Chronic Kidney Disease
Criteria
1. Kidney damage for 3 months, as defined by structural or
functional abnormalities of the kidney, with or without
decreased GFR, manifest by either :
Pathological abnormalities; or
Markers of kidney damage, including
Abnormalities in the composition of the blood or
urine, or abnormalities in imaging tests
Level of GFR
Rate of GFR Decline (mL/min/1.73 m2 per year)
(mL/min/1.73 m2) 10 8 6 4 2 1*
90 7.5 9.4 13 19 38 75
80 6.5 8.1 11 16 33 65
70 5.5 6.8 9.2 14 28 55
60 4.5 5.6 7.5 11 23 45
50 3.5 4.4 5.8 8.8 16 35
40 2.5 3.1 4.2 6.3 13 25
30 1.5 1.9 2.5 3.8 7.5 15
20 0.5 0.6 0.8 1.3 2.5 5
Average age-related GFR decline after age 20-30 year
MDRD Study: average rate of decline in GFR is 4 ml/min/year. 85% declined,15% stabile or improvement
The risk for loss of kidney function
Type Definition Examples
Susceptibility Increased susceptibility to Older age, family history
factors kidney damage
Initiation factors Directy initiate kidney damage Diabetes, high blood
pressure, autoimmune
diseases, systemic
infections, urinary tract
infections, urinary stones,
lower urinary tract
obstruction, drug toxicity
Progression Cause worsening kidney Higher lavel of proteinuria,
factors damage and faster decline in higher blood pressure
kidney function after initiation level, poor glycemic
of kidney damage control in diabetes,
smoking
Endstage Increase morbidity and Lower dialysis dase (KW),
factors mortality in kidney failure temporary vascular
access, anemia, low serum
albumin, late referral
Attemps to prevent and correct
acute decline on chronic renal
failure
Volume depletion
IV radiographic contrast
Antimicrobial agent (aminoglycoside,amphotericine B)
NSAID (including Cox2)
ACE/ARB
Cyclosporine and tacrolimus
Obstruction of the urinary tract
Infection of urinary tract
Interventions that have been proven to be
effective
1. Transplantasi ginjal
2. Hemodialisis
3. Continuos Ambulatory Perito-
neal dialysis
INDIKASI RENAL
REPLACEMENT THERAPY
CHRONIC KIDNEY DISEASE
Increased creatinine
UO < 0.5 ml/kg/h
Risk x1.5 or GFR
x 6 hr
decrease > 25% High
Increased creatinine Sensitivity
UO < 0.5 ml/kg/h
Injury x2 or GFR decrease
x 12 hr
> 50%
heater
PV
Advantage
no arterial access
BLD
V
large molecules
heparin
V exact filtration
PA
Disadvantages
complex machinery
UF R expensive