Referat Gagal Ginjal Kro nik
Referat
Gagal Ginjal Kronik
Disusun oleh :
Indriana Rahmawati Suhendra (406161045)
Pembimbing :
dr. Albert Tri Rustamadji, SpPD, FINASIM
KEPANITERAAN ILMU PENYAKIT DALAM RSUD RAA SOEWONDO
PATI
PERIODE 13 FEBRUARI 2017 – 22 APRIL 2017
FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA JAKARTA
Defnisi
Suatu proses patofsiologi terkait dengan gangguan
fungsi ginjal dan penurunan progresif laju fltrasi
glomerulus.1
Abnormalitas struktur atau fungsi ginjal yang timbul
selama >3 bulan, dengan implikasi terhadap kesehatan
dan diklasifkasikan berdasarkan penyebab, kategori
laju fltrasi glomerulus, dan kategori albuminuria. 2
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s principles of internal medicine 19th edition.
United States: McGraw-Hill Education; 2015.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the
evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Kriteria Gagal Ginjal Kronik
Kriteria gagal ginjal kronik (KDIGO 2013) :
Petanda kerusakan ginjal (1 atau lebih) :
Albuminuria (AER ≥30 mg/24 jam; ACR ≥30 mg/g [≥3
mg/mmol])
Sedimen urin abnormal
Kelainan elektrolit akibat kelainan tubular
Kelainan yang dideteksi dengan pemeriksaan histologi
Kelainan structural yang dideteksi dengan pencitraan
Riwayat transplantasi ginjal
Penurunan laju fltrasi glomerulus (LFG)
LFG < 60 ml/menit/1,73 m2 (Kategori LFG G3a-G5)
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Epidemiologi Gagal Ginjal
Kronik
Indonesian Renal Registry. 7th report of Indonesian renal registry. IRR: 2014.
Klasifkasi
Penyeb
ab
Klasifkasi
(KDIGO
2013) :
Kategori
LFG
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Albuminu
ria
Penyebab
Nefropati diabetic
Glomerulonefritis
Hipertensi terkait GGK (termasuk penyakit ginjal iskemik
dan vascular dan penyakit glomerular primer terkait
hipertensi)
Penyakit ginjal polikistik dominan autosom
Nefropati kistik dan tubulointerstitial lainnya
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s
principles of internal medicine 19th edition. United States: McGraw-Hill
Education; 2015.
Etiologi Gagal Ginjal Kronik di Indonesia
Indonesian Renal Registry. 7th report of Indonesian renal registry. IRR: 2014.
Kategori Laju Filtrasi
Identifcation,
Glomerulus
KDIGO 2013
Evaluation, and
Management of CKD3
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Albuminuria
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Rumus Estimasi LFG
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s
principles of internal medicine 19th edition. United States: McGraw-Hill
Education; 2015.
Faktor Risiko
Tidak Dapat Dimodifkaai
Dapat Dimodifkaai
Usia tua
Hipertensi
Jenis kelamin (♂ lebih cepat)
Proteinuria
Ras (Afrika-Amerika lebih cepat) Albuminuria
Hilangnya massa ginjal
Glikemia
Genetik
Obesitas
Dislipidemia
Merokok
Kadar asam urat
Papadakis MA, McPhee SJ, Rabow MW. Current medical diagnosis &
treatment 2017 56th edition. United States: McGraw-Hill Education; 2017.
Patofsiologi
Stadium
dini
• Hilangnya daya cadang ginjal (LFG N/↑)
• ↓ fungsi nefron progresif
• Asimptomatik
LFG 60%
• Keluhan nokturia, lemah, mual, ↓ nafsu makan, ↓ BB
LFG 30%
LFG
Gagal Ginjal Kronik
Disusun oleh :
Indriana Rahmawati Suhendra (406161045)
Pembimbing :
dr. Albert Tri Rustamadji, SpPD, FINASIM
KEPANITERAAN ILMU PENYAKIT DALAM RSUD RAA SOEWONDO
PATI
PERIODE 13 FEBRUARI 2017 – 22 APRIL 2017
FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA JAKARTA
Defnisi
Suatu proses patofsiologi terkait dengan gangguan
fungsi ginjal dan penurunan progresif laju fltrasi
glomerulus.1
Abnormalitas struktur atau fungsi ginjal yang timbul
selama >3 bulan, dengan implikasi terhadap kesehatan
dan diklasifkasikan berdasarkan penyebab, kategori
laju fltrasi glomerulus, dan kategori albuminuria. 2
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s principles of internal medicine 19th edition.
United States: McGraw-Hill Education; 2015.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the
evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Kriteria Gagal Ginjal Kronik
Kriteria gagal ginjal kronik (KDIGO 2013) :
Petanda kerusakan ginjal (1 atau lebih) :
Albuminuria (AER ≥30 mg/24 jam; ACR ≥30 mg/g [≥3
mg/mmol])
Sedimen urin abnormal
Kelainan elektrolit akibat kelainan tubular
Kelainan yang dideteksi dengan pemeriksaan histologi
Kelainan structural yang dideteksi dengan pencitraan
Riwayat transplantasi ginjal
Penurunan laju fltrasi glomerulus (LFG)
LFG < 60 ml/menit/1,73 m2 (Kategori LFG G3a-G5)
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Epidemiologi Gagal Ginjal
Kronik
Indonesian Renal Registry. 7th report of Indonesian renal registry. IRR: 2014.
Klasifkasi
Penyeb
ab
Klasifkasi
(KDIGO
2013) :
Kategori
LFG
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Albuminu
ria
Penyebab
Nefropati diabetic
Glomerulonefritis
Hipertensi terkait GGK (termasuk penyakit ginjal iskemik
dan vascular dan penyakit glomerular primer terkait
hipertensi)
Penyakit ginjal polikistik dominan autosom
Nefropati kistik dan tubulointerstitial lainnya
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s
principles of internal medicine 19th edition. United States: McGraw-Hill
Education; 2015.
Etiologi Gagal Ginjal Kronik di Indonesia
Indonesian Renal Registry. 7th report of Indonesian renal registry. IRR: 2014.
Kategori Laju Filtrasi
Identifcation,
Glomerulus
KDIGO 2013
Evaluation, and
Management of CKD3
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Albuminuria
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Rumus Estimasi LFG
Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s
principles of internal medicine 19th edition. United States: McGraw-Hill
Education; 2015.
Faktor Risiko
Tidak Dapat Dimodifkaai
Dapat Dimodifkaai
Usia tua
Hipertensi
Jenis kelamin (♂ lebih cepat)
Proteinuria
Ras (Afrika-Amerika lebih cepat) Albuminuria
Hilangnya massa ginjal
Glikemia
Genetik
Obesitas
Dislipidemia
Merokok
Kadar asam urat
Papadakis MA, McPhee SJ, Rabow MW. Current medical diagnosis &
treatment 2017 56th edition. United States: McGraw-Hill Education; 2017.
Patofsiologi
Stadium
dini
• Hilangnya daya cadang ginjal (LFG N/↑)
• ↓ fungsi nefron progresif
• Asimptomatik
LFG 60%
• Keluhan nokturia, lemah, mual, ↓ nafsu makan, ↓ BB
LFG 30%
LFG