ASUHAN KEPERAWATAN PADA PASIEN DENGAN

CHRONIC RENAL FAILURE

A. Pengertian
Gagal ginjal kronis (Chronic Renal Faillure/CRF) didefinisikan sebagai nilai
laju filtrasi glomerulus (GFR) yang berada dibawah batas normal selama lebih dari 3
bulan. Banyak penyakit menyebabkan gagal ginjal kronis, termasuk
glomerulonefritis (30%), nefritis interstisial dan nefropati refluks (20%), penyakit
ginjal polikistik (10%), uropati obstruktif, dan penyakitpenyakit lain yang tidak
diketahui (20%). Insidensi gagal ginjal kronis yang perlu mendapatkan terapi
penggantian ginjal adalah 65100/1.000.000 populasi/tahun dan 500/1.000.000
pasien menjalani terapi gagal ginjal stadium akhir (ESRF) (Davey, 2005).
Pasein dianggap telah masuk dalam stadium gagal ginjal kronik bila hasil
tes kreatinin klirens (CCT) kurang dari 25 ml/menit atau kreatinin darah lebih dari 5
mg/dl. Berdasarkan hasil CCT, gagal ginjal kronik dibagi atas:
 100-75 ml/menit disebut cadangan ginjal menurun
 75-26 ml/menit disebut gagal ginjal kronik
 kurang dari 5 ml/menit disebut gagal ginjal terminal
Menurunnya faal ginjal pada CRF umumnya progresif, berlangsung
beberapa bulan sampai beberapa tahun dan melampaui tahapa-tahapan sebagai
berikut:
1. Tahap decrease renal reserve
Pada tahap ini ginjal berfungsi antara 40-75 % dari fungsi ginjal normal. Kadar
ureum dan kreatinin masih dalam batas normal dan belum menunjukkan
adanya gejala akumulasi sisa metabolisme. Sekitar 50-60% jaringan ginjal
mengalami kerusakan.
2. Tahap renal insufisiensi
Ginjal masih berfungsi 20-40%. Telah terjadi penurunan laju filtrasi glomerulus,
gangguan ekskresi dan non ekskresi sehingga kadar ureum dan kreatinin
plasma meningkat. Terjadi gangguan dalam buang air kecil dan anemia.
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 b) Hitung darah lengkap : Ht menurun, Hb biasanya kurang dari 7-8

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10) Seksualitas
Gejala : penurunan libido, amenorea, infertilitas.
11) Interaksi social
Gejala : kesulitan menentukan kondisi, contoh tidak mampu bekerja,
memepertahankan fungsi peran biasanya dalam keluarga.
12) Penyuluhan / pembelajaran
Gejala : riwayat DM keluarga (resiko tinggi untuk gagal ginjal), penyalit
polikistik, nefritis herediter, kalkulus urinaria, malignansi. Riwayat terpajan
pada toksin, contoh obat, racun lingkung an. Penggunaan antibiotic
nefrotoksik saat ini / berulang.
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Smeltzer, Suzanne C. dan Bare, Brenda G. 2002. BUKU AJAR Keperawatan