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PENYAKIT GINJAL KRONIK
PGK)/CRONIC KIDNEY DISEASE CKD)
Siswanto030.09.237
Fak. KedokteranUniv. Trisakti
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Definisi
Suatu proses patofisiologis dengan etiologiyang beragam, mengakibatkan penurunan
fungsi ginjal yang progresif, dan pada
umumnya berakhir dengan gagal ginjal.
Gagal ginjal: suatu keadaan klinis yang ditandai
dengan penurunan fungsi ginjal yang
ireversibel, pada suatu derajat yang
memerlukan terapi pengganti ginjal yang tetap,
berupa dialisis atau transplantasi ginjal.
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Anatomi Ginjal
Kapsul renalis
Hilus
Ureter
Vena renalis
Arteri renalis
Korteks renalis
Medulla renalis
Kolumna renalis Pelvis renalis
Kaliks mayor
Kaliks minor
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Fisiologi Ginjal
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FUNCTION OF URINARY SYSTEM
Excretionrefers to the elimination of
metabolic wastes that were cell metabolites;
this is the function of the urinary system.
Kidneys play a role in homeostasis of the
blood by excreting metabolic wastes, and by
maintaining the normal water-salt and acid-
base balances of blood.
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Excretion of Metabolic Wastes
Kidneys excrete nitrogenous wastes,including urea, uric acid, and creatinine.
Ureais a by-product of amino acidmetabolism.
The metabolic breakdown of creatinephosphate in muscles releases creatinine.
Uric acidis produced from breakdown of
nucleotides. Collection of uric acid in joints causes gout.
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Maintenance of Water-Salt Balance
Kidneys maintain the water-salt balanceof thebody which, in turn, regulates blood pressure.
Salts, such as NaCl, in the blood cause osmosis
into the blood; the more salts, the greater theblood volume and also blood pressure.
Kidneys also maintain correct levels of
potassium, bicarbonate, and calcium ions inblood.
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Secretion of Hormones
Kidneys secrete or activate several hormones:1) They secrete the hormone erythropoietinto
stimulate red blood cell production,
2) They activate vitamin D to the hormonecalcitriolneeded for calcium reabsorptionduring digestion, and
3) They release renin, a substance that leads to
the secretion of aldosterone.
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Etiologi
Penyakit ginjal diabetes: DM tipe 1 dan 2
Penyakit ginjal non diabetes: glomerular (autoimun,
infeksi sistemik, obat/toksin, neoplasia), vaskular
(hipertensi, makroangiopati, mikroangiopati),tubulointerstisial (PNK, batu, obstruksi, obat/toksin),
keracunan obat, ginjal polikistik
Penyakit pada transplantasi: rejeksi kronik, transplant
glomerulopathy
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MULTIPLE RISK FACTORS FOR CKD
Clinical factors:
Diabetes
Hypertension
Autoimmune disease
Systemic infections
Exposure to drugs associated
with acute decline in kidney
function
Recovery from acute kidneyfailure
Sosiodemographic factors:
Older age
Family history of kidney
disease
Reduced kidney mass
Racial/ethnic background
Smoking
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Patofisiologi
Penyakit etiologi Pengurangan massa ginjal Maladaptasi
Hipertrofi/sklerosis
struktural dan
fungsional nefron
Penurunan
fungsi nefron
yang progresif
Peningkatan
aktivitas RAA
intrarenal
Hiperfiltrasi
Peningkatan
hiperfiltrasi dan
sklerosis
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Manifestasi Klinis
Sesuai penyakit yang mendasari
Sindrom uremia: lemah, letargi, anoreksia,mual, muntah, nokturia, kelebihan volume
cairan, sesak napas, nokturia, neuropatiperifer, pruritus, perikarditis, kejang-kejang,sampai koma.
Gejala komplikasi: hipertensi, anemia, asidosismetabolik, osteodistrofi renal, gagal jantung,gangguan keseimbangan elektrolit
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Management of Chronic Kidney Disease
Blood glucose control
BP Control
ARBs
ACE Inhibitors
Interventions that delay progression
Reduced Functioning and Well-being
Malnutrition
Osteodystrophy
Anemia
Prevention of Uremic Complications
(GFR < 60 cc/min/1.73 m2)
Cardiovascular Disease
Modifcation of Comorbidity
Pre-emptive Transplantation
Kidney Transplant Evaluation
Timely Dialysis Initiation
Timely Dialysis Access Placement
Choice of Dialysis Modality
Education
An "ESRD Clinic"
Preparation for Renal Replacement Therapy
(GRF < 30 cc/min/1.73m2)
Early Detection of CKD
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EVALUATING PATIENTS AT RISK FOR CKD
Evaluating risk factors and identifying GFR
declines are essential to the prompt and
appropriate management of CKD
GFR or age/weight-sensitive eGFR
Blood pressure
Glucose
Urinalysis
Microalbuminuria/proteinuria
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COMORBIDITIES AND COMPLICATIONS OF CKD
Anemia
Hypertension
Cardiovascular disease
Diabetes
Osteodystrophy
Malnutrition
Metabolic acidosis
Dyslipidemia
Deficits in functioning
and well-being
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EVALUATION OF ANEMIA
Hemoglobin and/or hematocrit
Red-blood-cell indices
Reticulocyte count Iron parameters
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TREATMENT OF ANEMIA
Iron supplementation (IV/PO)
EPO
Erythropoiesis stimulating agents
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CONSEQUENCES OF METABOLICACIDOSIS
Abnormal renal handling of ions
Tubular-phosphate reabsorption
Filtered load of calcium and phosphate Tubular-calcium reabsorption
Increased resorption of bone
Increased muscle catabolism
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TREATMENT OF METABOLIC ACIDOSIS IN CKD
Goal
Serum HCO3-: > 20 mEq/l
pH > 7.35
Agents
Sodium bicarbonate tablets (650 mg = 8 mEq HCO3-)
Sodium citrate (Shohls solution)
Dose of HCO3-:
1,01,5 mEq/kg/day
Dependent upon initial serum HCO3-and degree of renalinsufficiency.
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Rumus pemberian bikarbonat:
Rerata Ru-Bikar x BB x HCO3-
Ru-Bikar = [0,4 + (2,6: [HCO3-]) x BB
HCO3- = HCO3
- targetHCO3- sekarang
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