Nefropati Diabetik

Seminar Temu Alumni FKUGM-83

Yogyakarta, 28 Pebruari 2020
Diabetes is a global heath challenge1,2

Diabetes is expected to grow 73% by 2045

736 MILLION2
PATIENTS
Only ONE in TWO adults with diabetes know
that they have diabetes.1
73%
425 MILLION2 INCREASE
PATIENTS
Many patients have poor glycaemic control –
and poor control can lead to costly, life-
9/22/21 MILLION1 threatening complications2-4:
PATIENTS
AMPUTATIONS BLINDNESS

HEART DISEASE KIDNEY FAILURE

9/22/21 9/22/21 2045

References: 1. International Diabetes Federation. IDF Diabetes Atlas, 2 ed. Brussels, Belgium: International Diabetes
Federation, 2003. 2. International Diabetes Federation. IDF Diabetes Atlas, 8ed. Brussels, Belgium: International Diabetes
Federation, 2017. 3. Harris S et al., Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes
in Canada evaluation study). Diabetes Research and Clinical Practice 2005; 70:90–97. 4. UK Prospective Diabetes Study
(UKPDS) Groups. Lancet 1998: 352 (9131):837-53. 5. The Diabetes Control and Complications Trial Research Group. N Engl J
Med 1993;329(14):977-86.
RISKESDAS 2018: 10,9% Prevalence of DM in Indonesia
5
Pengertian
Laju Filtrasi Glomerolus ( LFG, GFR :
Glomerular Filtration Rate) : Jumlah
volume darah (serum) yang dibersihkan
oleh ginjal per-unit waktu ( ml/ menit)
Menghitung LFG :
1. Dengan Rumus (Cockcroft Gault)
2. Aplikasi ( aplikasi android ,iOS)
Penyakit ginjal kronik
(PGK) : kerusakan atau
penurunan fungsi ginjal
( LFG) yang telah terjadi > 3
bulan dengan implikasi pada
kesehatan
Definisi
Sindrom klinis pada penderita DM yang
ditandai dengan albuminuria menetap (>
300mg/24 jam ) pada minimal 2 kali
pemeriksaan dalam kurun waktu 3 sampai 6
bulan
dan/ atau
- Kerusakan glomeruler
- Penurunan LFG
ADA recommendations, Diabetes Care, January 2012
Mekanisme proteinuria
Faktor Risiko
Riwayat keluarga menderita DM
Hipertensi
Hiperglikemia tidak terkontrol
Dislipidemia
Obestas
Laki-laki
Perokok
Diagnosis
Diabetes + Penurunan fungsi ginjal dan :
1. Makroalbuminuria ATAU
2. Mikroalbuminuria (+) Retinopati,
menderita DM-tipe 1 selama 10
tahun atau lebih

KDOQI, 2007
Penurunan fungsi ginjal non- ND
1. Tidak ditemukan retinopati
2. Penurunan LFG yang progresif
3. Proteinuria progresif
4. Hipertensi refrakter
5. Sedimen-sedimen urin
6. Gejala penyakit sistemik lainnya ( SLE,
dll)
7. Penurunan LFG >30% dalam 2-3 bulan
setelah pemberian obat hipertensi
golongan ACE-i atau ARB
 SCREENING FOR NEPHROPATHY

WHEN: Type 1 - annually after puberty and 5 years of DM

Type 2 - at diagnosis and then annually

WHAT: random urine ACR; Suspicion of

and random urine Yes
nondiabetic
dipstick renal disease?
Workup or referral
for nondiabetic renal
No
disease
Normal Macroalbuminuria
< 2.0 mg/mmol men Check ACR > 20 mg/mmol men
< 2.8 mg/mmol women results > 28 mg/mmol women
Rescreen in 1 year Diabetic nephropathy
Microalbuminuria diagnosed
2.0 - 20 mg/mmol men
2.8 - 28 mg/mmol women

Any 2 abnormal out of 3

Only 1 abnormal ACR: Up to 2 repeat random urine ACRs: Diabetic
Repeat screen in 1 year ACRs performed 1 week to 2 nephropathy diagnosed
months apart

1/26/2014 21
 Recommendations for the Comprehensive Management
of T2DM Patients with CKD
Factor Recommendations
Lifestyle factors diet, exercise, smoking,and alcohol intake

Blood glucose Treatment goal:

HbA1c <6.5%
Preprandial plasma glucose 90-130 mg/dl
Postprandial plasma glucose <180 mg/dl

Blood pressure Goal ≤130/80 mm Hg

Use maximal tolerated dose of ACE inhibitor or ARB before
adding a second agent

Cholesterol Goal <4.0 mmol/L for total cholesterol and <2.0 mmol/L for
LDL-C
Consider use of a statin irrespective of baseline lipid values for
the secondary prevention of cardiovascular disease

Platelets Consider use of low dose aspirin for the secondary prevention
of cardiovascular disease

Monitoring Annual monitoring of eGFR and ACR

Take Home Message
Nefropati diabetik adalah komplikasi
jangka panjang dari DM
Karakteristik : proteinuria, penurunan
LFG dan hipertensi
Skrining dan intervensi dini dapat
mencegah atau memperlambat perburukan
fungsi ginjal
Deteksi dini, pencegahan dan pemerataan pelayanan,
untuk kesehatan ginjal bagi semua