ckd bobby putri

8/11/2019 CKD Bobby Putri

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CHRONIC KIDNEY

DISEASEBobby Laksana DPutri Priela

Pembimbing : dr. Nursamsu, SpPD


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EPIDEMIOLOGY CKD is common among adults in the United States.

More than 10% of people, or more than 20 million, aged

20 years or older in the United States have CKD. More than 35% of people aged 20 years or older with

diabetes have CKD.

More than 20% of people aged 20 years or older withhypertension have CKD

CDC, 2010


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DEFINITION OF CHRONIC

KIDNEY DISEASECriteria

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

2. GFR < 60 mL/min/1.73 m2for 3 months, with or without

kidney damage

NKF-K/DOQI, 2002


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K/DOQI 2003

Stages of Chronic Kidney Disease

Stage Description GFR(mL/men/1.73m2)

1 Kidney damage with normal

GFR atau

90

2 Kidney damage with mild GFR 6089

3 Moderate GFR 3059

4 Severe GFR 1529

5 Kidney failure < 15 (atau dialysis)

Penyakit ginjal kronik didefinisikan sebagai kerusakan ginjal atau GFR < 60

mL/men/1.73m2selama > 3 months. Kerusakan ginjal didefinisikan sebagai kelainan

patologis atau adanya petanda adanya kerusakan, termasuk kelainan dalam test darah

atau urin atau pemeriksaan radiologis


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In the last stage of chronic kidney disease,occuredazotemia and uremia. Worsening metabolic

acidosis, which is noticeably stimulate breathingrate. Arise hypertension, anemia, hyperkalemia,uremic encephalopathy. Congestive heart failurecan occur and pericarditis. Without treatmentoccurred coma and death


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PROGRESSION OF CKD Irreversible renal damage

Progressive decreased of GFR (4 ml/min/year)

Further kidney damage can be slowed by interveningon the factors that accelerate kidney damage


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INTERVENTIONS TO SLOWTHE PROGRESSION OF

KIDNEY Interventions that have been proven to be effective

include:

(1) Strict glucose control in diabetes;(2) Strict blood pressure control;

Interventions that have been studied, but the resultsof which are inconclusive, include:

(1) Dietary protein restriction;(2) Lipid-lowering therapy;

(3) Partial correction of anemia.

NKF-K/DOQI, 2002


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SCREENING FOR CKD

Rationale : early detection, early intervention, reducedassociated complications, high prevalence silentkidney disease

- standart urine dipstick (spot urine): proteinuria

hematuria, lekosituria- serum creatinine

- blood pressure

- ultrasound imaging(obstruction,stones,infection,PKD)

- serum electrolytes

- urinary concentration


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WHEN SHOULD BE

REFERRED When creatinine clearance


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Otak : - letargi, malaise- bingung- koma- kejang

Konjungtiva : - kemerahan- kalsifikasi- perubahan fundus karena hipertensi

Mulut :- napas uremik

Dada : - hiperventilasi karena asidosis- edema paru, efusi

Abdomen :- ginjal & kandung kemih teraba- bruitsginjal

Urin :- simptom penyakit ginjal

- poliuri, frekuensi, nokturi

Perifer :- edema tungkai- neuropati perifer

- peningkatan penyakit vaskuler

- deformitas tulang pd anak

Genital : - impotensi- libido menurun

- amenore, mandul

Lengan & tangan :

- lecet- bekas garukan- lekonikia

- tremor- flap- myoclonic jerks

Tekanan darah : - meningkat- turun saat berdiri

Jantung : - pembesaran jantung

- perikarditis

Tekanan vena jugularis :- tinggi atau rendah

Wajah : - pucat- warna keabu-abuan

- uraemic frost

Manifestasi

Klinik Uremia


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MANIFESTASI KLINIK CKD(BIASANYA MANIFES PADA KK


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Koreksi faktor reversibel & correctable

Faktor pre renal : hipovolemia ,dekompensasi kordis,hipotensi,

stenosis arteri renal

Faktor post renal : membebaskan obstruksi post renal oleh karena

batu, prostat, keganasan rongga pelvis

Mengobati penyakit dasar faktor renal : DM, hipertensi, Wegeners

granulomatosis, lupus nefritis dll

Eradikasi infeksi kuman t.u yg di traktus urogenitalis : ISK, sepsis


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MEASURES TO PREVENT THE

PROGRESSION OF CKD Dietary protein restriction : 0,60,8 g/kg BB

Lipid lowering : cholesterol total


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PENGOBATAN KHUSUS GEJALA &KELUHAN

GGK

1. Anemia- Fe- asam folat- eritropoetin- transfusi

2. Gatal

- diet rendah protein- difenhidramin

3. Mual- diet rendah protein

4. Hiperuricemia : alupurinol5. Hiperkalemi : glukose dan insulin,diit rendah

kalium,cation exchange resin6. Asidosis : nabic infus dan tablet7. Overload syndrome : balans cairan, diuretik


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Klirens kreatinin < 15 ml/m (DM)

Klirens Kreatinin < 10 ml/men (non DM)

Sindroma Uremik

Hiperkalemia

Asidosis Metabolik

Kelebihan Cairan (overload)

KAPAN DILAKUKAN RENAL

REPLACEMENT THERAPY ?


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MODALITAS RENAL

REPLACEMENT THERAPY Hemodialisis (HD)

Chronic ambulatory peritoneal dialysis (CAPD)

Kidney transplant


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HD


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CAPD


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KIDNEY

TRANSPLANT


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