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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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