FARMAKOTERAPI Peny Ginjal

Background
Uncontrol
Hypertensive
Hypertensive Draws, P ; Rahman, M ; M,
Prevalence
Laine, C. et.al. Chronic Kidney
Disease- Screening and
GFR < 15 ml/ HD Prevention. Annals of Internal
min
Medicine. 2009.
Mortality

Diabetic

Uncontrol
Diabetic Metformin

Glomerular
demage
Kidney Diseases
• Acute Kidney Disease (Gagal Ginjal Akut)
• Chronic Kidney Disease (Gagal Ginjal Kronik)
Adopted from Kidney Disease
Guideline
Klasifikasi CKD
1. Dari Nilai GFR
Stag Description GFR (ml/min/1,73 Related Terms

e m2)

1 Kidney Damage with normal or ≥ 90 Albuminuria,

increasing of GFR Proteinuria,

Hematuria

2 Kidney damage with mild reducing of 60-89 Albuminuria,

GFR Proteinuria,

Hematuria

3A Midly to moderately decrease 40-59 Chronic Renal

Insufficiency,

3B Moderately to severely decreased 30-44 Early Renal

Insufficiency

4 Severe reducing of GFR 15-29 Chronic Renal

Insufficiency, Late

Renal Insufficiency,

Pre-ESRD

5 Kidney Failure < 15 (or dialysis) Renal failure,

Uremia, End-Stage

Renal Disease
2. Dari Nilai Albumin

Stage Description Albumin

A1 Normal to mildly increased < 30 mg/g

< 3 mg/mmol

A2 Moderately increased 30-300 mg/g

3- 30 mg/mmol

A3 Severely increased > 300 mg/g

> 30 mg/mmol
Tanda-Tanda CKD
No Component Causal
1 Symptoms and Signs of Early Stages of  Weakness
CKD  Decreased appetite
 Nausea
 Changes in urination (polyuria, frequency)
 Blood in urine or dark-colored urine
 Foamy or bubbly urine
 Loin pain
 Edema
 Elevated blood pressure
 Pale skin

2 Symptoms and Signs of Late (Uremic)
Stages of CKD
 General (lassitude , fatigue , elevated blood pressure , signs of volume overload , decreased mental
acuity , intractable hiccups , uremic fetor )
 Pulmonary (dyspnea , pleural effusion , pulmonary edema , uremic lung )
 Cardiovascular (periCardial friction rub ,congestive heart failure )
 Gastrointestinal ( anorexia , nausea , vomiting, weight loss , stomatitis , unpleasant taste in the mouth
)
 Neuromuscular ( muscular twitches , peripheral sensory and motor neuropathies, muscle cramps ,
restless legs ,sleep disorders , hyperrefl exia , seizures , encephalopathy , coma )
 Endocrine-metabolic ( decreased libido , amenorrhea , impotence )
 Hematologic ( anemia , bleeding diathesis )
Perhitungan ClCr
1. MDRD (Modification of Diet in
Renal Disease) equation

• GFR in mL/min per 1.73 m2 = 186.3x(serum

creatinine)−1.154 x(age)-0.203x (1.210 if
black)x(0.742 if female)
2. Cockcroft−Gault equation
• Creatinine clearance in mL/min = {[(140 −age) x
weight in kg] / (72x serum creatinine in
mg/dL)}x(0.85 if female).
Adoted from Google Image
and Also Comparing with
Kidney Disease Guideline
The Process of The CKD (Chronic
Kidney Disease)

Adopted from Kidney Disease

Guideline
Komplikasi Penyakit Ginjal
References
• (K/DOQI) Kidney Disease Outcomes Quality Initiative. (2004). K/DOQI Clinical Practice Guidelines on Hypertension and
Antihypertensive Agents in Chronic Kidney Disease. Am J Kidney Dis, 43(Supp 1), S1-290.
• Abboud, H., & Henrich, W. (2010). Clinical Practice Stage IV Chronic Kidney Disease. New England Journal of Medicine,
362, 56–65.
• Almeida, F. A. De, Ciambelli, G. S., Bertoco, A. L., Jurado, M. M., Siqueira, G. V., Bernardo, E. A., Gianini, R. J.
(2015). Family Clustering of Secondary Chronic Kidney Disease with Hypertension or Diabetes Mellitus. A Case-
Control Study. Ciência & Saúde Coletiva, 20(2), 471–478. https://doi.org/10.1590/1413-81232015202.03572014
• Annual Data Report Minnepolis. (2006). Renal Data System U.S.
• Arora, P. (2016). Medscape: chronic Kidney Disease Treatment & Management.
• Association, U. K. R., Mactier, R., Nephrologist, C., Infirmary, G. R., & Glasgow, N. H. S. G. (2007). Clinical Practice
Guidelines Module 2 : Haemodialysis. American Journal of Kidney Diseases.
• Barclay, L. (2013). CKD: KDIGO Guidelines Recommend Wider Use of Statins.
• Besarab, A., & W.Coyne, D. (2010). Iron Supplementation to Treat Anemia in Patients with Chronic Kidney Disease. Nature
Reviews Nephrology, 6(12), 699–710.
• Biesenbach, G., & Pohanka, E. (2011). Antidiabetic Therapy in Type 2 Diabetic Patients on Hemodialysis. Special Problems
in Hemodialysis Patients, 85–97.
• Bohlke, M., Nunes, D. L., Marini, S. S., Kitamura, C., Andrade, M., & Von-Gysel, M. P. O. (2008). Predictors of quality of
life among patients on dialysis in southern Brazil. São Paulo Medical Journal = Revista Paulista de Medicina, 126(5), 252–
6.