Gagal ginjal Kronik

Definisi

1. keruskan ginjal >/= 3 bulan abnormalitas struktur dan fungsi ginjal ++/- penurunan GFR manifest : 1. Abnormalitas pathologi, 2. Marker kerusakan ginjal abnormalitas komposisi urin/darah/imaging.

2. GFR<60 mL/min/1,73 m3 u/ >/= 3 bulan dgn/tanpa kerusakan ginjal.

Clinical action plan penyakit ginjal kronis.

STAGE Diskripsi GFR Action1 Krusakan ginjal +

N/peningkatan GFR

>/= 90 mL/min1,73 m2 -diagnosis dan treatment-treatment kondisi komorbid-memperlambat progression-mengurangi resiko CVD

2 Kerusakan ginjal + penurunan GFR

60-89 Estimasi progression

3 Pen. GFR sedang 30-59 Evaluasi dan mengobati komplikasi4 Pen. GFR berat 15-29 Persiapan terapi replacement ginjal5 Gagal ginjal <15 (dyalisis) Replacement (kalo ada uremia)

Evaluasi pasien

Pasien CKD harus ditentukan

1. Diagnosis (tipe peny. Ginjal)2. Kondisi komorbid3. Drajat keberatan + penilaian fungsi ginjal4. Komplikasi, berhub. Dgn fungsi ginjal5. Resiko u/ kehilangann fungsi ginjal6. Resiko u/ penyakit kardiovaskular

treatment penyakit ginjal kronik

1. Terapi spesifik berdasarkan diagnosis2. Evaluasi dan management kondidi komorbid3. Perlambat penurunan fungsi ginjal4. Cegah + pengobati penyakit CV5. Cegah + mengobati komplikasi penurunan fungsi ginjal6. Persiapan gagal ginjal dan replacement terapi7. Tanda dan gejala uremia ganti fungsi ginjal dialysis dan transplantasi

Medikasi 1. Dosis disesuaikan fungsi ginjal2. deteksi ES pada fungsi ginjal/ komplikasi penyakit ginjal kronis.3. Interaksi obat4. Terapi + monitoring5. self management

7. kalo action plan ga berhasil harus dirujuk ke spesialist, GFR < 30mL/min/1.73 m2 rujuk nephrologist.

EVALUASI PENILAIA LABORATORIUM u/ PENILAIAN KLINIS PENYAKIT GINJALPenilaian GFR, proteinura dan marker lain.

1. GFR dari persamaam konsentrasi serum kreatinin, + umur, JK, ras, ukuran tubuh | persamaan dewasa MDRD study dan cockcoft – Gault

Anak” schwartz dan couna han-barratt

Sampel urin 24 jam informasi usefull :1. Perkiraan GFR kecuali dietary intake (vegetarian diet, suplement kreatinin_) + muscle

mass ( amputasi, malnutrisi, muscle wasting)2. Perhitungan diet & status nutrisi3. Perlu u/ memulai dialysis

Penilaian Proteinuria - Normal protein dalam urin (sedikit) peningkatan protein persisten marker kerusakan ginjal. - protein yg di ekskresiin spesifik albumin dan LMWG albumin meningkat (peny. Gagal ginjal kronik, krn diabetes, peny. Glomerular, dan HTN), |LMWG peningkatan ekskresi penyakit tubulointerstitial.- proteinuria peningkatan ekskresi albumin, protein spesifik lain, protein total.-mikroalbuminuria eksresi albumin diatas sange normal dibawah dr kadar prot. total.-albuminuria peningkatan albumin.

‘‘albuminuria’’ refers specifically to increasedurinary excretion of albumin. ‘‘Microalbuminuria’’ refers to albumin excretion above the normalrange but below the level of detection by tests for total protein. Guidelines for detectionand monitoring of proteinuria in adults and children differ because of differences in the prevalenceand type of chronic kidney disease.

Guidelines for Adults and Children:Under most circumstances, untimed (‘‘spot’’) urine samples should be used to detect andmonitor proteinuria in children and adults.It is usually not necessary to obtain a timed urine collection (overnight or 24-hour) forthese evaluations in either children or adults.First morning specimens are preferred, but random specimens are acceptable if firstmorning specimens are not available.In most cases, screening with urine dipsticks is acceptable for detecting proteinuria:Standard urine dipsticks are acceptable for detecting increased total urine protein.Albumin-specific dipsticks are acceptable for detecting albuminuria.Patients with a positive dipstick test (1_ or greater) should undergo confirmation ofproteinuria by a quantitative measurement (protein-to-creatinine ratio or albumin-to-creatinineratio) within 3 months.Patients with two or more positive quantitative tests temporally spaced by 1 to 2 weeksshould be diagnosed as having persistent proteinuria and undergo further evaluationand management for chronic kidney disease as stated in Guideline 2.Monitoring proteinuria in patients with chronic kidney disease should be performedusing quantitative measurements.