5 Desember 2019

Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s principles of internal medicine 19th edition. United States:
McGraw-Hill Education; 2015.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and
management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO
2012 clinical practice guideline for the evaluation and management of chronic kidney
disease. Kidney Int Suppl. 2013;3:1–150.
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s
principles of internal medicine 19th edition. United States: McGraw-Hill Education; 2015.
Indonesian Renal Registry. 7th report of Indonesian renal registry. IRR: 2014.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO
2012 clinical practice guideline for the evaluation and management of chronic kidney
disease. Kidney Int Suppl. 2013;3:1–150.
 Tidak Dapat Dimodifikasi Dapat Dimodifikasi
Usia tua Hipertensi
Jenis kelamin (♂ lebih cepat) Proteinuria
Ras (Afrika-Amerika lebih cepat) Albuminuria
Hilangnya massa ginjal Glikemia
Genetik Obesitas
Dislipidemia
Merokok
Kadar asam urat

Papadakis MA, McPhee SJ, Rabow MW. Current medical diagnosis & treatment 2017
56th edition. United States: McGraw-Hill Education; 2017.
 Sistem Organ Gejala Tanda
Umum Lemas, kelelahan Tampak pucat
Kulit Pruritus, mudah digaruk Pucat, ekimosis,
ekskoriasi, edema
THT Rasa kecap logam, epistaksis Urinous breath
Mata Konjungtiva pucat
Paru-paru Napas pendek Rales, efusi pleura
Kardiovaskular Dispneu, nyeri retrosternal saat Hipertensi, kardiomegali,
inspirasi (pericarditis) friction rub
Gastrointestinal Anorexia, mual, muntah
Genitourinaria Nokturia, disfungsi ereksi isothenuria
Neuromuskular Restless legs, ensefalopati uremikum
Neurologi Iritabilita secara umum, Stupor, asterixis, neuropati
ketidakmampuan konsentrasi perifer
 ↑ ureum
Hiperkalemia
↑ serum
kreatinin hipokalsemia
hiperfosfatemia
hipermagnesemia
Elektrolit

Pemeriksaan Lab darah

Penunjang lengkap Hiperkolesterolemia
Glukosa darah, Hipertrigliseridemia
profil lipid ↑ LDL

Asidosis
Analisa gas
metablok (pH ↓,
darah
HCO3 ↓)

Papadakis MA, McPhee SJ, Rabow MW. Current medical diagnosis & treatment 2017
56th edition. United States: McGraw-Hill Education; 2017.
 Urinalisa Sedimen urin : sel tubulus
Albumin urin ginjal, sedimen eritrosit,
Protein urin leukosit, sedimen granuler
kuantitatif 24 jam kasar, eritrosit dismorfik

USG Abdomen
Pemeriksaan BNO-IVP
Penunjang

Biopsi ginjal

EKG
Cegah Komplikasi Röntgen thorax
echocardiography

Papadakis MA, McPhee SJ, Rabow MW. Current medical diagnosis & treatment 2017
56th edition. United States: McGraw-Hill Education; 2017.
Derajat LFG Rencana tatalaksana
(mL/mnt/1,7
3 m2)
1 ≥90 Terapi penyakit dasar, kondisi komorbid, evaluasi
perburukan fungsi ginjal, perkecil risiko
kardiovaskular
2 60-89 Hambat perburukan fungsi ginjal
3 30-59 Evaluasi dan terapi komplikasi
4 15-29 Persiapan untuk terapi pengganti ginjal
5 <15 Terapi pengganti ginjal
 Aspek Dikontrol Target Obat
Tekanan darah <130/80 mmHg (tanpa proteinuria) ACE inhibitor, ARB,
tinggi <125/75 mmHg (dengan CCB nondihidropiridin
proteinuria)
Glukosa darah HbA1C <7% Gol. Glitazon
Lipid LDL <100 mg/dL statin
Trigliserida ≥200 mg/dL  target
kolesterol nonHDL <130 mg/dL
 Komplikasi Koreksi Obat
Anemia Hb ≤10 g/dL dan Ht ≤30% Epo 2000-4000 IU subkutan,
 Hb 10-12 g/dL, Ht 2-3x/minggu selama 4 minggu
>30%
Asidosis metabolik HCO3 <22 mmol/L Bicnat 3x2 tab (325-2000 mg)
Rumus koreksi : 0,3 x BB x
∆[HCO3]
Hiperhomosisteinemia As. Folat 15 mg
vit. B12 500µg/hari
Hiperfosfatemia Calcium carbonat 3-6 g/hari
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO
2012 clinical practice guideline for the evaluation and management of chronic kidney
disease. Kidney Int Suppl. 2013;3:1–150.