PENYAKIT GINJAL KRONIS

(Chronic Kidney Disease)

PADA ANAK

Anggono R. Arfianto S.
Pediatrician
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Daftar singkatan

AKI
: acute kidney injury
GFR : glomerular filtration rate
HSP : henoch schnlein purpura
LFG : laju filtrasi glomerulus
PGK : penyakit ginjal kronis
SLE
: systemic lupus
erithematosus
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Pendahulua
n

Chronic Kidney Disease

kidney damage 3 months

structural /functional abnormalities
with/without decreased GFR
manifest by
pathological or
markers
GFR <60 mL/minute/1.73 m2 with/without
kidney damage for 3 months.

Anonim. National kidney foundation. Kidney disease outcomes quality initiative. Clinical practice guidelines for
chronic kidney disease : evaluation, classification, and stratification. Executive summary.New york, 2002.

Penyakit ginjal kronis

Pendahulua
n

kerusakan ginjal 3 bulan

abnormalitas struktur & fungsi
ginjal
LFG
normal/ turun
Abnormalitas
Petanda
patologis

kerusakan
ginjal

GFR < 60 mL/menit/1,73m, 3

bulan
dengan/tanpa abnormalitas
Anonim. National kidney foundation. Kidney disease outcomes quality initiative. Clinical practice guidelines for
chronic kidney disease : evaluation, classification, and stratification. Executive summary.New york, 2002.

Stadium

Pendahulua
n

Stage 1 : kidney disease

GFR >90 mL/minute/1.73m2
Stage 2 : kidney damage
GFR 60-89 mL/minute/1.73m2
Stage 3 : moderate decrease
GFR 30-59 mL/minute/1.73m2
Stage 4 : severe decrease
GFR 15-29 mL/minute/1.73m2
Stage 5 : kidney failure
GFR <15 mL/minute/1.73m2 or on
dialysis/terminal
KDOQI (2002)
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Pendahulua
n

Epidemiologi
Amerika
2% dari populasi PGK stadium terminal (usia<20
th) prevalensi 32%. Angka harapan hidup 20 tahun
Departemen Ilmu Kesehatan Anak RSU dr. Soetomo
(2005-2010)
53 px PGK usia 3 bln s/d 15 th) 14 stadium
terminal

Patogenesis

Patogenesis

Infeksi, trauma fisik, obat, gangguan imun & metabolik

Jejas, proses keradangan kronis, & penyembuhan

Penyakit Ginjal Kronis

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Patogenesis

Faktor Resiko CKD

Faktor klinis

SLE, HSP
Sindrom nefrotik
Sindrom nefritik
Infeksi sistemik
Batu saluran kemih
Infeksi saluran kemih
Neoplasia
Riwayat keluarga PGK (+)
Penyembuhan dari AKI
Paparan obat/zat tertentu
BBLR

Faktor sosiodemografi

Usia lebih tua

Etnis Afroamerika, Indian,
Hispanik, Asian atau
kepulauan Pasifik
Paparan bahan
kimia/kondisi lingkungan
tertentu
Income/pendidikan rendah

Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol 2007; 22:19992009

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Patogenesis

Gambar skema terjadinya jejas

Segerer S, Nelson PJ, Schl Ondorff D. Chemokines, chemokine receptors, and renal disease: from basic science to pathophysiologic and therapeutic
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studies. J Am Soc Nephrol 2000; 11: 15276

Patogenesis

30-36%
12%
EMT
EndMT
7%
35%

Strutz F, Muller GA. Renal fibrosis and the origin of the renal fibroblast.
Nephrol Dial Transplant 2006; 21: 336870
12

Patogenesis

Kalluri R, Weinberg RA. The basics of epithelial-mesenchymal transition. J Clin

Invest 2009; 119: 14208.
13

Patogenesis

Penyakit ginjal kronis

penurunan
aliran
darah ke
ginjal

mediator
inflamasi

fibrosis
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Patogenesis

Gambar keseimbangan & ketidakseimbangan sintesis & degradasi matriks

Eddy AA. Molecular basis of renal fibrosis. Pediatr Nephrol 2000; 15: 290301

15

Patogenesis

fibrosi
s
Kerusakan struktur
Akumulasi fibroblas & protein matriks ekstraseluler

destruksi

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Manifestasi Klinis

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Manifestasi

Gangguan
Keseimbangan cairan dan
elektrolit
Keseimbangan asam basa
Metabolisme lemak
Metabolisme karbohidrat
Metabolisme kalsium
Metabolisme fosfat
Metabolisme hormon

Gangguan

Fungsi CVS
Neurologi
Perkembangan seksual
Perdarahan

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Tatalaksana

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Tatalaksana

Konservatif

Replacement

Atasi faktor reversibel

Dialisis
LFG <10 mL/menit/1,73
/yang memperberat
Hipertensi
Diet
Gagal jantung
Obat
anti
hipertensi

Perikarditis
Antisipasi kelainan
Neuropati
jantung
Osteodistrofi ginjal
Pengobatan anemia
Depresi sumsum tulang
Gagal tumbuh
Menjaga pertumbuhan &
perkembangan
Transplantasi ginjal
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ZAT BESI
Memelihara enzym perkembangan &
fungsi sel
Efek terhadap lingkar kepala
Fungsi global SSP, daya ingat
Transport oksigen
(hemoglobin/myoglobin)
Sintesis neurotransmiter (tyrosine
hydroksilase)
Keterlambatan
motorik &hantar
kognisiimpuls
Myelinisasi kecepatan
Keterlambatan
kognisi persisten
sel saraf
Fungsi
sel lekosit
Elektrofisiologi
abnormal

 Nutrient penting dengan batas rasio

terapeutik-toksik yang sangat sempit

Dendritic Arborization

Terimakasih

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