Komplikasi DM dan HT

GAGAL GINJAL

Prolanis Arjowinangun
Juli 2018
dr. Muhammad Azhar Rosyidi
STRUCTURE OF THE KIDNEYS
Gagal Ginjal adalah ?
 Definisi Gagal Ginjal
• Kerusakan Ginjal >3 bulan
– Gangguan fungsi atau kerusakan organ
dengan atau penurunan laju filtrasi ginjal
• Penurunan laju filtrasi ginjal >3 bulan
Prevalence of CKD
 Fungsi ginjal
Regulasi volume cairan tubuh
Regulasi keseimbangan elektrolit
Regulasi keseimbangan asam basa
Regulasi tekanan darah (RAAS)
Ekskresi sampah metabolik
Regulasi erithropoesis
Metabolisme vit D
Sintesis prostaglandin
Penyebab Gagal Ginjal

 Glomerulonefritis
 Penyakit ginjal bawaan
 Hipertensi
 Penyumbatan saluran
 Infeksi
 Nefropati diabetik
 Penyebab Gagal Ginjal

Other Glomerulonephritis
Other Glomerulonephritis
10% 13%

Diabetes Hypertension

50.1% 27%

Primary Diagnosis for Patients Who Start on Dialysis

 Pe Reabs Na
Hipertrofi sel renal
Pe eksr sisa metab

Ggn konstentrasi urin

Pe ekskr kalium

Penurunan GFR Ggn fs ekskresi Pe ekskr PO4

Pe ekskr ion H

CKD

Ggn Reproduksi

Ggn Imun
Ggn fs non ekskresi
 prod eritropoetin

Pe abs Ca
JENIS PEMERIKSAAN
PENUNJANG

• Pemeriksaan Urin
• Evaluasi Fungsi Ginjal
• Evaluasi Serologis
• Pemeriksaan Radiologis
• Biopsi Ginjal
 Gejala Gagal Ginjal Stadium 3-5

• Berat Badan turun tanpa sebab jelas

• Mual Muntah
• Lemas, Pusing, sering cegukan
• Gatal seluruh tubuh
• Penurunan atau peningkatan jumlah kencing
• Sering kencing pada malam hari
• Mudah perdarahan
 Gejala Gagal Ginjal Stadium 3-5

• Muntah darah atau BAB darah

• Penurunan kesadaran atau mudah kram
• Kejang dan darah tinggi
• Gangguan syaraf tepi / kesemutan
• Breath fetor; Loss of appetite;
• Kelainan kulit karena ureum
• Gagal jantung karena ureum
 STAGES OF CKD

NORMAL INCREASED RISK DAMAGE LOW GFR

CKD
DEATH RENAL FAILURE
COMPLICATIONS
 Kecenderungan pasien Gagal Ginjal
Faktor
Faktor Resiko Komplikasi
Mempercepat
• Diabetes • Protein pada urin • Stroke
• Hypertension • Tekanan darah tinggi • Anemia
• Usia Lanjut • Gula darah tidak • Gangguan tulang
terkontrol
• Riwayat keluarga
• Merokok
• Etnis
• Kolesterol tinggi
• Other: low income, minimal
education, kidney-mass • Penggunaan obat
reduction, known kidney
disease

Levey et al. Ann Intern Med. 2003;139:137-147.

USRDS. 1999 Annual Data Report. Available at: www.usrds.org.
 Specific Interventions for Complications
of CKD
Complication Intervention Target Goals
Diabetes Glycemic control preprandial glucose 90-125 mg/dL
A1C <7%

Hypertension BP control < 130/80 mm Hg

Secondary HPT PTH control CKD stage 3 = 35-70 pg/mL
4 = 70-110 pg/mL
Dyslipidemia Maintain lipids to target LDL-C <100 mg/dL (70?) TG
<150 mg/dL
HDL-C >40 mg/dL
Anemia Reach Hgb goal 11-12 g/dL
Malnutrition Dietary modification Adequate energy intake

A1C = glycosylated hemoglobin; HPT = hyperparathyroidism; PTH = parathyroid hormone; LDL-C = low-density
lipoprotein cholesterol; TG = triglycerides; HDL-C = high-density lipoprotein cholesterol; Hgb = hemoglobin.
 Summary: Clinical Actions for Progressive
Stages of CKD
CKD GFR
Stage Description (mL/min/1.73 m2) Action*
Risk At increased risk 90 with Evaluate for CKD
CKD risk factors Reduce/control CKD risk factors

Kidney damage with Diagnose and treat comorbid conditions

1 normal 90 Address progression factors
or  GFR Reduce/control CVD risk factors

Kidney damage with Estimate progression

2 60-89
mild  GFR *All actions for prior stages
Evaluate and treat complications
3 Moderate  GFR 30-59
*All actions for prior stages
Prepare for kidney replacement
4 Severe  GFR 15-29
Evaluate and treat complications

5 Kidney failure <15 or dialysis Kidney replacement if uremia present

*Actions for each progressive stage of CKD also include all the actions for prior stages.
NKF. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.
 Penatalaksanaan CKD

Ditujukan untuk mengurangi gejala klinik , mencegah komplikasi ,

mencegah progresifitas CKD, mempersiapkan initiasi dialisis

Uremia : diit protein 0,6 – 0,8 gr / kg bb / hari

Hiperkalemia : diit rendah kalium ; 60 – 80 meq/hari
Asidosis metabolik : diit rendah protein / fosfat; HCO3

Stop rokok
Kontrol lipid ( preparat statin )
HbA1C < 7 %

Hipertensi
Anemia
Osteodistrofi renal
Komplikasi kardiovaskuler
Critical ill patient potentially AKI