ckd .ppt
DESCRIPTION
Mengenai Gagal ginja;TRANSCRIPT
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Pendahuluan
Definisi :
Berkurangnya laju filtrasi glomerular menahun yang disertai dengan peningkatan kreatinin serum dan penurunan kreatinin klirens
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Causes of ESRD in Indonesia in Haemodialysis Unit (2000):
Causes Incidence
Glomerulonephritis 46.39 %
Diabetes Mellitus 18.25 %
Obstructive and Infection 12.85 %
Hypertension 8.46 %
Other causes 13.65 %
Buku Ajar Ilmu Penyakit Dalam Jilid 1, hal 582
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Etiologi
1. Glomerupathies#Primary Glomerular Disease- Focal & segmental glomerulosclerosis- Membranoproliferative glomerulonephritis- IgA nephropathy- Membranous nephropathy
#Secondary Glomerular Disease- Diabetic nephropathy- Amyloidosis- Post infectious glomerulopathy- HIV associated nephropathy- Collagen vascular disease- Sickle cell nephropathy- HIV associated membranoproliferative glomerulonephritis
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Etiologi (2)
2. Tubulo Interstitial Nephritis* Drug hypersensitivity* Heavy metals* Analgesic nephropathy* Reflux / chronic nephropathy* Idiopathic
3. Hereditary Disease* Polycystic kidney disease* Medullary cystic disease* Alport’s syndrome
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Etiologi (3)
4. Obstructive Nephropathies* Prostatic Disease
* Nephrolithiasis* Retroperitoneal fibrosis / tumor* Congenital
5. Vascular Disease* Hypertensive nephrosclerosis
* Renal artery sclerosis
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KLASIFIKASI
Stadium Deskripsi LFG (mL/min/1,73 m2)
1 Kerusakan ginjal dengan LFG normal
> 90
2 Kerusakan ginjal dengan LFG ringan
60 - 89
3 Penurunan LFG sedang 30 - 59
4 Penurunan LFG berat 15 - 29
5 Gagal ginjal < 15 / dialisis
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Symptoms and SignsOrgan System Symptoms Signs
General Fatigue, weakness Sallow-appearing, chronically ill
Skin Pruritus, easy bruisability Pallor, ecchymoses, excoriations, edema, xerosis
ENT Metalic taste in mouth , epistaxis Urinous breath
Eye Pale conjunctiva
Pulmonary Shortness of breath Rales, pleural effusion
Cardiovascular Dyspnea on exertion, retrosternal pain on inspiration (pericarditis)
Hypertension, cardiomegaly, friction rub
Gastrointestinal Anorexia, nausea, vomiting, hiccups
Genitourinary Nocturia, impotence Isosthenuria
Neuromuscular Restless legs, numbness and cramps in leg
Neurologic Generalized irritability and inabilty to concentrate, decreased libido
Stupor, asterixis, myoclonus, peripheral neuropathy
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Diagnosis
1. Peningkatan BUN2. Peningkatan creatinine3. Anemia4. Asidosis metabolik5. Hiperfosfatemia6. Hipokalsemia7. Hiperkalemia8. Isothenuria
Pemeriksaan Penunjang :USG : kedua ginjal mengecil dengan gambaran
ecogenic < 10 cm
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MANAJEMEN CKD
1. Kontrol tekanan darah proteinuria <1 gr/hari 130/85 mmHg proteinuria >1 gr/hari 125/75 mmHg
2. Penyekat EKA3. Restriksi protein
pengurangan intake protein 0,6 – 1 gr / kgBB / hari intake kalori 30-35 kcal/kgBB/hari
4. Serum bikarbonat dipertahankan 22 mmol/L
5. Anemia suplementasi Fe mencapai kadar feritin serum = 100ug/L eritropoetin sampai Hb >11gr/dL
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MANAJEMEN CKD
6. Kalsium dan fosfat Konsultasi diet Pengikat fosfat non aluminium jika kadar fosfat serum >1,5mmol/l Metabolit vit D aktif jika kadar PTH >2,5 x normal dan kadar
fosfat serum <1,5mmol/l7. Dislipidemia (LDL >100 , HDL <40 , trigliserida >180)
Konsultasi diet ; olahraga ; statin , fibrat8. Persiapan vena
Vena cephalic untuk fistula9. Infeksi
Skrining hepatitis , vaksinasi hepatitis B10. Konseling
masalah psikososial, sosioekonomi,stop merokok
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Terapi Pengganti Ginjal
A. Dialisisa. Hemodialysis Dilakukan 3 – 5 jam
Indikasi : * Uremic syndrome * Overload yang tidak respon terhadap diuretik * Hiperkalemi (K > 5) * Asidosis metabolik * Timbul gejala neurologi (kejang / neuropati)
* GFR < 15 ml / mnt * Kreatinin serum > 8 mg / dl
b. Peritoneal Dialysis (PD) * CAPD (Continuous Ambulatory PD) * CCPD (Continuous Cyclic PD)
B. Transplantasi Ginjal
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Komplikasi
Hiperkalemia Gangguan asam basa Komplikasi kardiovaskuler
hipertensi perikarditis CHF
Komplikasi hematologi anemia koagulapati
Komplikasi neurologi Komplikasi metabolisme mineral Komplikasi endokrin
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KOMPLIKASI
KARDIOVASKULORENAL- 40 % meninggal akibat komplikasi kardiovaskuler- Hubungan antara jantung dengan ginjal :
* CKD merupakan faktor resiko PKV* Faktor resiko pad PKV akan mempercepat terjadinya CKD* PKV merupakan faktor terjadinya CKD
- Faktor-faktor resiko pada CKD yang memperberat PKV : hipertensi, anemia, substansi uremik, mikroalbuminuria, hipertensi dan diabetes, dislipidemia, merokok dan sindrom metabolik- Penatalaksanaan : ACEI, betabloker dan spironolakton
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TERIMA KASIHSELAMAT BELAJAR