Beruflich Dokumente
Kultur Dokumente
Dr. Syamsudin
Department of Pharmacology
Faculty of Pharmacy
Pancasila University
• Fungsi ginjal
Regulasi volume cairan tubuh
Regulasi keseimbangan elektrolit
Regulasi keseimbangan asam basa
Regulasi tekanan darah (RAAS)
Ekskresi sampah metabolik
Regulasi erithropoesis
Metabolisme vit D
Sintesis prostaglandin
Brain ADH
Renin
Angiotensin II
Kidney
Hepar RAAS
Diagnostic Tools for Assessing Renal
Failure
• Blood Tests
– BUN
– Creatinine
– K+
– PO4
– Ca
• Urinalysis
– Specific gravity
– Protein
– Creatinine clearance
4
BUN
• Normal 10-30 mg/dl
• Nitrogenous waste product of protein
metabolism
• Unreliable in measurement of renal function
5
Creatinine
• A waste product of muscle metabolism
• Normal value 0.5 - 1.5 mg/dl
• 2 times normal = 50% damage
• 8 times normal = 75% damage
• 10 times normal = 90% damage
6
Diagnostic Tools
• Biopsy
• Ultrasound
• X-Rays
7
Gambaran Klinis GGA
• HB normal
• Oliguric type
• Non oliguric type (30-60%) – prognosis lebih
baik – causa AB / nephrotoxic agent
• Umumnya “reversible”
• Mortalitas tinggi: 40-60%
• Frekuensi : 5-15% pasien rawat
Penyebab GGA
• Pre-renal : Hypovolemic, hypotensi, dehydrasi,
syok
• Renal (Intrinsic renal failure) – ATN (acute
tubular nephrosis) or VMN (vascular
membrane nephrosis)
• Post-renal : obstruksi, batu, prostat, trauma,
keganasan.
Anamnesis
• Gastro Enteritis akut
• Riwayat tindakan / operasi
• Hipotensi shock
• Hipertensi (accelerated / malignant)
• Drugs
• Renal disease
• Acute on chronic
Clinical Course of ARF
• Onset Phase : oliguria, ureum creatinin
meningkat, gangguan elektrolit
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Pe Reabs Na
Hipertrofi sel
renal Pe eksr sisa
metab
Ggn konstentrasi
urin Pe ekskr kalium
Ggn Reproduksi
Ggn Imun
Ggn fs non
ekskresi prod
eritropoetin
Pe abs Ca
Causes of Chronic Renal Failure
• Diabetes
• Hypertension
• Glomerulonephritis
• Cystic disorders
• Developmental - Congenital
• Infectious Disease
18
Causes of Chronic Renal Failure
• Neoplasms
• Obstructive disorders
• Autoimmune diseases
• Hepatorenal failure
• Scleroderma
• Amyloidosis
• Drug toxicity
19
Glomerular Filtration Rate
GFR
• 24 hour urine for creatinine clearance
– Most accurate indicator of Renal Function
– Reflects GFR
– Formula:
• urine creatinine X urine volume
serum creatinine
• Can estimate creatinine clearance by:
Men: {140 – age} x IBW (kg)
72 x serum creatinine
Women: {140 – age} x IBW (kg)
85 x serum creatinine
20
Stages of Chronic Renal Failure
Old System
• Reduced Renal Reserve
• Renal Insufficiency
21
Stages of Chronic Renal Failure
NKF Classification System
Stage 1:
GFR >/= 90 ml/min despite kidney damage
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Stages of Chronic Renal Failure
NKF Classification System
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During Stage 1 - 2
• No symptoms
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Stages of Chronic Renal Failure
NKF Classification System
25
Stages of Chronic Renal Failure
NKF Classification System
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During Stage 3 - 4
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During stages 3 - 4
• 75% nephron loss
• Decreased: glomerular filtration rate, solute
clearance, ability to concentrate urine and
hormone secretion
• Symptoms: elevated BUN & Creatinine, mild
azotemia, anemia
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Stages of Chronic Renal Failure
NKF Classification System
29
During Stage 5
End Stage Renal Disease
• Residual function < 15% of normal
• Excretory, regulatory and hormonal functions
severely impaired.
• Metabolic acidosis
• Marked increase in: BUN, Creatinine,
Phosphorous
• Marked decrease in: Hemoglobin,
Hematocrit, Calcium
• Fluid overload
30
During Stage 5
• Uremic syndrome develops affecting all body
systems
– can be diminished with early diagnosis &
treatment
31
Manifestations of Chronic Uremia
Fig. 47-5
32
Treatment Options
• Conservative Therapy
• Hemodialysis
• Peritoneal Dialysis
• Transplant
• Nothing
33
Conservative Treatment Goals
GOALS:
• Detect & treat potentially reversible causes of
renal failure
• Preserve existing renal function
• Treat manifestations
• Prevent complications
• Provide for comfort
34
Conservative Treatment
• Control
– Hyperkalemia
– Hypertension
– Hyperphosphatemia
– Hyperparthryoidism
– Hyperglycemia
– Anemia
– Dyslipidemia
– Hypothyroidism
– Nutrition
35
Penatalaksanaan CKD
Stop rokok
Kontrol lipid ( preparat statin )
HbA1C < 7 %
Hipertensi
Anemia
Osteodistrofi renal
Komplikasi kardiovaskuler
Pengobatan GGK
• Konservatif
– Diet : rendah protein: 0,6-08 g/KgBB
HBV kalori cukup