Case Report Session

CHRONIC KIDNEY DISEASE

(CKD)
Chronic Kidney Disease EPIDEMIOLOGI
Perhimpunan Nefrologi
Indonesia (Pernefri) tahun
2006, yang mendapatkan
prevalensi penyakit6%
ginjal
dari populasi
kronik sebesar 12,5%.
orang dewasa di 4,5% dari populasi
Amerika Serikat AS diperkirakan
mengalami CKD pada memiliki stadium
stadium 1 dan 2 3 dan 4 CKD

Hasil Riskesdas 2013 juga menunjukkan

prevalensi meningkat seiring dengan
bertambahnya umur, dengan
peningkatan tajam pada kelompok umur
35-44 tahun dibandingkan kelompok
umur 25-34 tahun
 Chronic Kidney Disease

Etiologi
Faktor Resiko

Penyebab penyakit ginjal kronik di Indonesia tahun 2015

Definition of CKD

Structural or functional abnormalities of the kidneys for >3 months, as manifested by either:

1. Kidney damage, with or without decreased GFR, as defined by

• pathologic abnormalities
• markers of kidney damage, including abnormalities in the composition of the blood or urine or abnormalities in
imaging tests
2. GFR <60 ml/min/1.73 m2, with or without kidney damage
 Chronic Kidney Disease

STAGING OF CKD

Sumber: KDIGO Clinical Practice: Guideline for the Evaluation and Management of CKD.
Classification of CKD by Etiological
Diagnosis
• Diabetic Kidney Disease
• Glomerular diseases (autoimmune diseases, systemic
infections, drugs, neoplasia)
• Vascular diseases (renal artery disease, hypertension,
microangiopathy)
• Tubulointerstitial diseases (urinary tract infection, stones,
obstruction, drug toxicity)
• Cystic diseases (polycystic kidney disease)
• Diseases in the transplant (Allograft nephropathy, drug
toxicity, recurrent diseases, transplant glomerulopathy)
 Chronic Kidney Disease PATOGENESIS
Penyakit yang Pengurangan
mendasari masa ginjal

Hipertrofi nefron
yang sehat

Hiperfiltrasi

Maladaptasi : ↑ tekanan kapiler

nefron sklerosis dan aliran darah
glomerulus

↓ fungsi nefron
yang progresif Chronic Kidney
Disease
PENDEKATAN DIAGNOSIS Gambaran klinis

Anamnesis
Gambaran Klinis
• Sesuai dengan penyakit yang
Pemeriksaan Fisik
mendasarinya (DM, ISK, BSK,
Hipertensi, hiperurikemia, SLE, dsb)
• Sindrom uremia lemah, letargi,
anoreksia, mual muntah, nokturia,
Pemeriksaan
Laboratorium kelebihan volume cairan, neuropati
Penunjang
perifer, pruritus, uremic frost,
perikarditis, kejang-kejang sampai koma
• Gejala komplikasinya antara lain,
hipertensi, anemia, asidosis metabolik,
Radiologis gangguan keseimbangan elektrolit
(sodium, kalium, khiorida)
 Chronic Kidney Disease
Gambaran
Laboratorium
• Penurunan fungsi ginjal berupa peningkatan kadar
ureum dan kreatinin serum, dan penurunan LFG
• Kelainan biokimiawi darah meliputi penurunan kadar
hemoglobin, hiper atau hipokalemia, hiponatremia,
hiper atau hipokloremia, hiperfosfatemia, hipokalsemia
• Kelainan urinalisis meliputi, proteiuria, hematuri,
leukosuria, cast, isostenuria
Gambaran
Radiologis
• Foto polos abdomen, bisa tampak batu radio-opak.
• Pielografi antegrad atau retrograd dilakukan sesuai
dengan indikasi.
• Ultrasonografi ginjal bisa memperlihatkan ukuran
ginjal yang mengecil, korteks yang menipis, adanya
hidronefrosis atau batu ginjal, kista, massa,
kalsifikasi.
• Pemeriksaan pemindaian ginjal atau renografi
dikerjakan bila ada indikasi.
• Biopsi dan Pemeriksaan Histopatologi Ginjal
Chronic Kidney Disease
Tatalaksana CKD

• Terapi spesifik terhadap penyakit dasarnya

• Pencegahan dan terapi terhadap kondisi komorbid (comorbid condition)
• Memperlambat pemburukan (progression) fungsi Ginjal
• Pencegahan dan terapi terhadap penyakit kardiovaskular
• Pencegahan dan terapi terhadap komplikasi
• Terapi pengganti ginjal berupa dialisis atau transplantasi ginjal
Clinical Practice Guidelines for the Detection,
Evaluation and Management of CKD
Stage Description GFR Evaluation Management
At increased
Test for CKD Risk factor management
risk
Diagnosis
Kidney
Comorbid Specific therapy, based on diagnosis
damage with
1 >90 conditions Management of comorbid conditions
normal or 
CVD and CVD Treatment of CVD and CVD risk factors
GFR
risk factors
Kidney
Rate of
2 damage with 60-89 Slowing rate of loss of kidney function 1
progression
mild  GFR
Moderate 
3 30-59 Complications Prevention and treatment of complications
GFR
Preparation for kidney replacement therapy
4 Severe  GFR 15-29
Referral to Nephrologist
5 Kidney Failure <15 Kidney replacement therapy
1
Target blood pressure less than 130/80 mm Hg. Angiotension converting enzyme inhibitors
(ACEI) or angiotension receptor blocker (ARB) for diabetic or non-diabetic kidney disease with spot
urine total protein-to-creatinine ratio of greater than 200 mg/g.
 Chronic Kidney Disease

Management of progression and complications of CKD

 Chronic Kidney Disease

Memperlambat pemburukan (progression) fungsi ginjal

Patogenesis Perburukan Fungsi Ginjal

 Chronic Kidney Disease

Pencegahan dan terapi terhadap komplikasi

Anemia
• Tranfusi darah : Sasaran hemoglobin menurut berbagai studi klinik adalah 11-12 g/dl
• EPO
Osteodistrofi renal
• Pembatasan asupan fosfat : Asupan fosfat dibatasi 600- 800 mg/hari
• Pemberian pengikat fosfat

Daftar Pengikat Fosfat

Terapi pengganti ginjal berupa dialisis atau transplantasi Ginjal

• Terapi pengganti ginjal dilakukan pada Penyakit Ginjal Kronik stadium 5, yaitu pada LFG kurang dari 15 ml/mnt.

• Terapi pengganti tersebut dapat berupa hemodialisis, peritoneal dialisis atau transplantasi ginjal
Referral to specialist kidney care services for people with
CKD in the following circumstances:
1. AKI or abrupt sustained fall in GFR;
2. GFR < 30 ml/min/1.73 m2 (GFR categories G4-G5)*;
3. Consistent finding of significant albuminuria (ACR ≥300 mg/g ≥30 mg/mmol] or AER
≥300 mg/ 24 hours, approximately equivalent to PCR ≥500 mg/g [≥50 mg/mmol] or PER
≥500 mg/24 hours);
4. Progression of CKD
5. Urinary red cell casts, RBC >20 per high power field sustained and not readily explained;
6. CKD and hypertension refractory to treatment with 4 or more antihypertensive agents;
7. Persistent abnormalities of serum potassium
8. Recurrent or extensive nephrolithiasis;
9. Hereditary kidney disease
Define CKD progression based on one of more of
the following :
1. Decline in GFR category G1, G2, G3a, G3b, G4, G5. A certain drop in eGFR is defined as a
drop in GFR category accompanied by a 25% or greater drop in eGFR from baseline.
2. Rapid progression is defined as a sustained decline in eGFR of more than 5 ml/min/1.73
m2 /yr.
3. The confidence in assessing progression is increased with increasing number of serum
creatinine measurements and duration of follow-up.
 Guide to Frequency of Monitoring (number of times
per year) by GFR and Albuminuria Category

Assess GFR and Prognosis

albuminuria at least
annually in people with
CKD. Assess GFR and
albuminuria more often
for individuals at higher
risk of progression,
and/or where
measurement will impact
therapeutic decisions (see
figure below).
 Chronic Kidney Disease

Komplikasi
Pendekatan Staging & komplikasi dan perencanaan
diagnosis CKD Progesifitas CKD komorbid terapi
Take Home Message
1. Penyakit ginjal kronik merupakan kerusakan ginjal yang terjadi lebih dari 3 bulan berupa
kelainan structural atau funsgional

2. Perjalanan penyakit ginjal kronis berlangsung secara perlahan namun pasti yang dapat ditandai
dengan peningkatan kadar Cr dan Ureum

3. Penting dilakukannya penilainnya GFR dan albuminuria setidaknya setahun sekali pada pasien
CKD dengan risiko progesifitas yang tinggi

4. Terapi pengganti ginjal dilakukan pada penyakit ginjal kronik stadium 5 yaitu LFG <15ml/mnt

5. Pada stadium 4 (GFR 15-29) sudah dapat dilakukan persiapan untuk terapi pengganti ginjal
Terima Kasih 