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History Long-standing history suggestsCKD

Renal osteodystrophy Ro” evidence of osteitis brosacystica or osteomalacia suggests

CKD

Renal size length!-small "# cm! CKD

-normal $K%

-enlarged&'( cm! Diabetec nephropathy

$myloidosis

)bstructive uropathy

H%*

+KD Renal biopsy Histologic diagnosis

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+tiology of K- which makes #atient must do

renal re#lacement thera#y

trans#lant,/-,"P-0

Disease %

Diabetes mellitus 40

Hypertension 25

Glomerulonephritis 15

Polycystic kidney disease 4

Urologic

Unkno!n " miscellaneous 10

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• Rationale , early detection early interventionreduced associated complications

• .hom / Diabetes hypertension autoimmunediseases urinary tract infection or obstructionheart failure cirrhosis family of 01RD family of

nephropathy D2H3glomerulonephritis!• Ho4/- standart urine dipstic5 spot urine!, proteinuria

  hematuria le5osituria- serum creatinine- blood pressure

- ultrasoundimagingobstructionstonesinfection+KD!- serum electrolytes- urinary concentration

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 AJKD 2002: 39(2)

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 AJKD 2002: 39(2)

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$nemia

Hipertensi)verload syndrome

6remia

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tak 2 - letargi, malaise- bingung- koma- kejang Konungti4a 2 - kemerahan

- kalsiikasi- !erubahan un"us karena hi!ertensi

!ulut 2 - na!as uremik

-ada 2 - hi!er#entilasi karena asi"osis- e"ema !aru, eusi

"bdomen 2 - ginjal $ kan"ung kemih teraba- bruits ginjal

5rin 2 - sim!tom !en%akit ginjal- !oliuri, rekuensi, nokturi

Perifer 2- e"ema tungkai- neuro!ati !erier 

- !eningkatan !en%akit #askuler 

- "eormitas tulang !" anak

Genital 2 - im!otensi- libi"o menurun- amenore, man"ul

(engan 6 tangan 2

- le&et- bekas garukan- lekonikia- tremor - flap- myoclonic jerks

7ekanan darah 2 - meningkat- turun saat ber"iri

8antung 2 - !embesaran jantung

- !erikar"itis

7ekanan 4ena ugularis 2- tinggi atau ren"ah

9aah 2 - !u&at- 'arna keabu-abuan

- uraemic frost 

Manifestasi

Klinik Uremia

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'7 $nemia  - 8e  - asam folat  - eritropoetin

 - transfusi(7 9atal  - diet rendah protein  - difenhidramin:7 2ual

- diet rendah protein;7 Hiperuricemia , alupurinol7 $sidosis , nabic infus dan tablet?7 )verload syndrome , balans cairan diureti5 

 

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Hemodialisis #HD$ hronic ambulatory peritoneal dialysis

#&PD$ 'idney transplant

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(hen creatinine clearance )*0 ml+min+1,-*m2 Patients at risk o. rapid progression

/n !hom doubt eists as to their diagnosis andprognosis

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Klirens kreatinin % 1: ml)m -!0

Klirens Kreatinin % 1' ml)men non -!0

;indroma 5remik

/i#erkalemia

"sidosis !etabolik

Kelebihan airan overload 0

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 hank you