CHRONIC KIDNEY DISEASE

REFERAT
KEPANITERAAN KLINIK ILMU PENYAKIT DALAM RS SULTAN SYARIF MOHAMMAD AL-KADRIE
FAKULTAS KEDOKTERAN UNIVERSITAS TANJUNGPURA
2017

ABIDAH BAZLINAH DERMAWAN 14061162040

PEMBIMBING: dr. AMANDA TRIXIE HARDIGALOEH, Sp. PD

DEFINISI KLASIFIKASI EPIDEMIOLOGI

ETIOLOGI PATOFISIOLOGI DIAGNOSIS

PENATALAKSANAAN

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 DEFINISI
CKD didefinisikan adanya abnormalitas struktur dan fungsi ginjal selama > 3 bulan

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 KLASIFIKASI

CKD diklasifikasikan berdasarkan penyebab, kategori GFR, dan kategori albuminuria

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 EPIDEMIOLOGI

Berdasarkan survey populasi data menunjukkan paling tidak 6% dari populasi dewasa
di US mengalami CKD stage 1 dan 2, dan 4,5% dari populasi US diestimasikan
mengalami stage 4 dan 5
Dinegara-negara berkembang, insiden ini diperkirakan sekitar 40-60 kasus perjuta
penduduk pertahun

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ETIOLOGI

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 PATOFISIOLOGI

Melibatkan mekanisme awal yang spesifik (terkait penyebab yang mendasari: abnormalitas
perkembangan/integritas ginjal secara genetik, deposisi kompleks imun, dan inflamasi pada jenis
glomerulonefritis tertentu, atau paparan toxin pada berbagai penayakit tubulus dan interstisium
renal)
Proses berjalan kronis progresif penurunan massa renal mekanisme kompensasi: nefron yang
masih baik mengalami hiperfiltrasi (oleh karena tekanan & aliran kapiler glomerulus) hipertrofi
distortion of glomerular architecture, abnormal podocyte function, and disruption of the filtration
barrier sklerosis dan dropout nefron yang tersisa
aktivitas RAS intrarenal initial adaptive hyperfiltration and subsequent maladaptive hypertrophy
and sclerosis
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PATOFISIOLOGI

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 GEJALA KLINIS

gejala yang timbul pada CKD erat hubungannya dengan penurunan fungsi ginjal:
Kegagalan fungsi ekskresi, penurunan GFR, gangguan resorbsi dan sekresi tubulus penumpukan toksin
uremik dan gangguan kesimbangan cairan, elektrolit dan asam-basa tubuh.
Kegagalan fungsi hormonal
Penurunan eritropoitin
Penurunan vitamin D3 aktif (kalsitriol)
Gangguan sekresi rennin dan Lain-lain

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 Sistem Organ Manifestasi Klinis
Umum Lemah, malaise, gangguan pertumbuhan dan debilitas,
edema
Kulit Pucat, rapuh, gatal, bruising
Kepala dan leher Fetor uremi
Mata Fundus hipertensi, mata merah
Jantung dan vaskuler Hipertensi, sindroma overload, paying jantung,
pericarditis uremik, tamponade
Respirasi Efusi pleura, nafas Kussmaul, pleuritis uremik
Gastrointestinal Anoreksia, mual, muntah, gastritis, ulkus, colitis
uremik, perdarahan saluran cerna
Ginjal Nokturia, poliuria, haus, proteinuria, hematuria
Reproduksi Penurunan libido, impotensi, amenorrhea, infertilitas,
genikomasti
Syaraf Letargi, malaise, anoreksia, drowsiness, tremor,
mioklonus, asteriksis, kejang, penurunan
kesadaran,koma
Tulang ROD, kalsifikasi jaringan lunak
Sendi Gout, pseudogout, kalsifikasi
Darah Anemia, kecendrunganberdarah karena penurunan
fungsi tromosit, defisiansi imun akibat penurunan
fungsi imunologis dan fagositosis

Endokrin Intoleransi glukosa, resistensi insulin, hiperlipidemia,

penueunan kadar testosterone dan estrogen 12

Farmasi Penurunan ekskresi lewat ginjal

 EVALUASI DAN MANAJEMEN PASIEN DENGAN CKD

INITIAL APPROACH: History

Symptoms and overt signs of kidney disease are often subtle or absent until renal failure supervenes.
history of hypertension (which can cause CKD or more commonly be a consequence of CKD), diabetes mellitus,
abnormal urinalyses, and problems with pregnancy such as preeclampsia or early pregnancy loss.
A careful drug history: use of analgesics, nonsteroidal anti-inflammatory agents, cyclooxygenase-2 (COX-2)
inhibitors, antimicrobials, chemotherapeutic agents, antiretroviral agents, proton pump inhibitors, and lithium.
In evaluating the uremic syndrome, questions about appetite, weight loss, nausea, hiccups, peripheral edema,
muscle cramps, pruritus, and restless legs are especially helpful.
A careful family history of kidney disease, together with assessment of manifestations in other organ systems such
as auditory, visual, and integumentary, may lead to the diagnosis of a heritable form of CKD (e.g., Alport or Fabry
disease, cystinosis)
or shared environmental exposure to nephrotoxic agents (e.g., heavy metals, aristolochic acid). 13
EVALUASI DAN MANAJEMEN PASIEN DENGAN CKD

Physical Examination
should focus on blood pressure and target organ damage from hypertension.
funduscopy and precordial examination (left ventricular heave, a fourth heart sound) should be
carried out.
Other physical examination include edema and sensory polyneuropathy.
The finding of asterixis or a pericardial friction rub not attributable to other causes usually signifies
the presence of the uremic syndrome.

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EVALUASI DAN MANAJEMEN PASIEN DENGAN CKD

Laboratory Investigations
penurunan fungsi ginjal perupa peningkatan kadar kreatinin serum untuk menentukan GFR.
Rasio protein/kreatinin atau rasio albumin
Kelainan biokimiawi darah meliputi penurunan kadar Hb, peningkatan kadar asam urat, elektrolit serum
(hiper atau hipokalemia, hiperfosfatemia, hipokalsemia, hiponatremia, hiper atau hipokloremia, asidosis
metabolik)
Kelainan urinalisis meliputi proteinuria, hematuria, lekosuria, cast

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EVALUASI DAN MANAJEMEN PASIEN DENGAN CKD

Imaging Studies
renal ultrasound: can verify the presence of two kidneys, determine if they are symmetric, provide an estimate of
kidney size, and rule out renal masses and evidence of obstruction.
the finding of bilaterally small kidneys supports the diagnosis of CKD of long-standing duration, with an
irreversible component of scarring.
The diagnosis of renovascular disease can be undertaken with different techniques, including Doppler sonography,
nuclear medicine studies, or CT or magnetic resonance imaging (MRI) studies.
Radiographic contrast imaging studies are not particularly helpful in the investigation of CKD. Intravenous or
intraarterial dye should be avoided where possible in the CKD patient risk of radiographic contrast dye
induced renal failure
Kidney Biopsy 16
 TREATMENT

Pengobatan penyakit dasar

Pengendalian keseimbangan air dan garam
Diet rendah protein, tinggi kalori
Pengendalian tekanan darah
Pengendalian gangguan keseimbangan elektrolit dan asam basa
Pengendalian dan pengobatan osteodistrofi renal (ODR)
Pengobatan gejala uremik spesifik
Deteksi dini dan pengobatan infeksi
Penyesuaian pemberian obat
Deteksi dan pengobatan komplikasi
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Persiapan dialisis dan transplantasi

 BP Control

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PROGNOSIS

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 PERJALANAN CKD
Conseptual model for development, progression, and complication of CKD
The model includes: risk for development of CKD, stages of diseases, complications including death

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 LEARNING POINTS

CKD is a general term for heterogeneous disorders affecting kidney structure and function with
variable clinical presentation, in part related to cause, severity and the rate of progression.
Recognition of CKD will have implications for the individual and their care.
Kidney failure is traditionally considered as the most serious outcome of CKD.
Symptoms are usually due to complications of decreased kidney function and when severe, they can be
treated only by dialysis or transplantation.
Earlier stages of kidney disease are often asymptomatic, are detected during the evaluation of comorbid
conditions, and may be reversible.
Rapidly progressive diseases may lead to kidney failure within months but most diseases evolve over
decades, and some patients do not progress during many years of follow-up.
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TERIMA KASIH

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