Diagnosis

Gangguan Ginjal
 Gangguan fungsi ginjal
• Klinis
Tanda, gejala, pemeriksaan fisik.
• Laboratoris
Ureum ↑, kreatitin ↑, asam urat ↑
• Tes klirens kreatinin (TKK)
Kreatinin urin(mg/dL) x vol.urin(mL/24 jam
Kreatinin serum(mg/dL) x 1440
• Rumus Cockrof-Gault

LFG = (140-umur) x BB (Kg)

72 x kreatinin serum (mg/dL

Wanita = 0,85 x pria

 Renal Failure
ACUTE & CHRONIC KIDNEY FAILURE
 Renal failure
Differentiation between acute and chronic renal failure

Acute Chronic

Short (days- Long

History
week) (month-years)
Haemoglobin
Normal Low
concentration

Renal size Normal Reduced

Renal osteodystrophy Absent Present

Peripheral neuropathy Absent Present

Serum Creatinine Acute reversible Chronic

concentration increase irreversible
 Acute renal failure
Renal failure
Chronic renal failure
Acute renal failure (ARF) or acute kidney injury
(AKI)

• Deterioration of renal function over a period of hours to days, resulting in

• the failure of the kidney to excrete nitrogenous waste products and
• to maintain fluid and electrolyte homeostasis
• ARF Rapid deterioration of renal function
• (increase of creatinine of >0.5 mg/dl in <72hrs.)
• “azotemia” (accumulation of nitrogenous wastes)
• elevated BUN and Creatinine levels
• decreased urine output (usually but not always)
• Oliguria: <400 ml urine output in 24 hours
• Anuria: <100 ml urine output in 24 hours
 Causes of acute renal failure

Hilton, R. BMJ 2006;333:786-790

 Acute Renal Failure
Diagnosis
• Laboratory Evaluation:
• Scr, More reliable marker of GFR
• Falsely elevated with Septra, Cimetidine
• small change reflects large change in GFR
• BUN, generally follows Scr increase
• Elevation may be independent of GFR
• Steroids, GIB, Catabolic state, hypovolemia
• BUN/Cr helpful in classifying cause of ARF
• ratio> 20:1 suggests prerenal cause
 Acute Renal failure
Causes of acute renal failure

Differentiation between Pre-renal, renal and post-renal causes

Prerenal Renal postrenal

Hypovolaemia Acute tubular necrosis Bilateral ureteric

Decreased active Interstinal nephritis obstruction
blood volume Glomerular disease (acute Unilateral ureteric
Decreased cardiac glomerulonephritis) obstruction
output Small vessel diease Bladder outflow
Renovascular Intrarenal vasoconstriction obstruction
obstruction (in sepsis)
Acute kidney injury stages
AKI STAGE Serum creatinine criteria Urine output criteria

1 Increase in serum creatinine of 26 Less than 0.5 ml/kg/hour

micromol/litre or more within 48 hours for more than 6 hours*
OR
1.5 to 2-fold increase from baseline

2 Increase in serum creatinine to more Less than 0.5 ml/kg/hour

than 2 to 3-fold from baseline for more than 12 hours

3 Increase in serum creatinine to more Less than 0.3 ml/kg/hour

than 3-fold from baseline for 24 hours or anuria for
OR 12 hours
Serum creatinine more than 354
micromol/litre with an acute increase of
at least 44 micromol/ litre
* Urine output of less than 0.5 ml/kg/hour more than 8 hours in children and young people
Detecting AKI (Acute kidney injury )
• Investigate for AKI when risks factors are present
• Compare serum creatinine with the patient’s baseline

Detect AKI using (p)RIFLE, AKIN, KDIGO criteria:

Serum creatinine rise ≥ 26 micromol/litre from baseline within

48 hours
Serum creatinine rise by 50% or more in 7 days

Urine output < 0.5ml/kg body weight/hour for 6

consecutive hours in adults

• Urine output < 0.5ml/kg/hour for more than 8 hours in children

and young people
• In children and young people – a 25% or greater fall in eGFR
DIAGNOSIS
1. Rapid time course (less than 48 hours)
2. Reduction of kidney function
a. Rise in serum creatinine
Absolute increase in serum
creatinine of ≥0.3 mg/dl
Percentage increase in serum
creatinine of ≥50%
b. Reduction in urine output,
defined as <0.5 ml/kg/hr for more
than 6 hours (about 210mL in 6
hours)
HUMAN REFERENCE RANGE OF SERUM
CREATININE
0.5 to 1.0 mg/dL (about 45-90 μmol/L)
for women
0.7 to 1.2 mg/dL (60-110 μmol/L) for
men.
 While a baseline serum creatinine of
2.0 mg/dL (150 μmol/L) may indicate
normal kidney function in a male body
builder, a serum creatinine of 1.2 mg/dL
(110 μmol/L) can indicate significant
renal disease in an elderly female
COMPLICATIONS
•Metabolic acidosis
•Hyperkalemia
•pulmonary edema
•end-stage renal failure
requiring lifelong dialysis or a
kidney transplant.
CHRONIC KIDNEY DISEASE
(CKD), ALSO KNOWN AS
CHRONIC RENAL DISEASE
 progressive loss
of renal function
over a period of
months or years.

IRREVERSIBLE
 Signs and symptoms
•increase in serum creatinine or
protein in the urine
•hypertension and/or suffering from
congestive heart failure
•Urea accumulates, leading to
azotemia and ultimately uremia
(symptoms ranging from lethargy to
pericarditis and encephalopathy).
•Urea is excreted by sweating and
crystallizes on skin ("uremic frost").
•Hyperkalemia : symptoms malaise and
potentially fatal cardiac arrhythmias
•Erythropoietin decreased = anemia, which
causes fatigue
•Fluid volume overload - mild edema to life-
threatening pulmonary edema
•Hyperphosphatemia - due to reduced
phosphate excretion
•hypocalcemia (due to vitamin D3 deficiency)-
tetany.--progresses to tertiary
hyperparathyroidism, with hypercalcaemia,
renal osteodystrophy and vascular
calcification that further impairs cardiac
function.
•Metabolic acidosis, due to accumulation
of sulfates, phosphates, uric acid etc. This
may cause altered enzyme activity by
excess acid acting on enzymes and also
increased excitability of cardiac and
neuronal membranes by the promotion of
hyperkalemia due to excess acid
(acidemia)
•accelerated atherosclerosis
•Cardiovascular disease-worse prognosis
 What are the causes?
Glomerular Disease Vascular Disease Infections
• Glomerulonephriti • Hypertension • Pyelonephritis
• Acute/chronic • Renal Artery • Tuberculosis
lupus Disease
erythematosis • Nephrosclerosis
• Polyarteritis
Nordosa
• Diabetes Mellitus

Interstitial Nephritis Hereditary Disease Obstructive Disease

• ChronicHypercalce • Polycyctic kidney • Calculi
mia disease • Tumors
• Chronic analgesic • Familial
ingestion amyloidosis
• Antibiotics, • Medullary cyctic
diuretics, other disease
drugs
32
Chronic kidney disease stages
Stage eGFR Description Qualifier
(ml/min/1.73m2)

1 ≥90 Kidney damage, normal or Kidney damage

increased GFR (presence of structural
2 60–89 Kidney damage, mildly abnormalities and/or
reduced GFR persistent haematuria,
proteinuria or
3A 45–59 Moderately reduced GFR microalbuminuria) for
+/- other evidence of ≥3 months
kidney damage
3B 30–44

4 14–29 Severely reduced GFR +/- GFR < 60 ml/min/1.73

other evidence of kidney m2 for ≥ 3months +/-
damage kidney damage