CHRONIC KIDNEY DISEASE

Putu Gede Ary Sanjaya

Introduction

Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR)

Epidemiology It has been estimated from population

survey data that at least 6% of the adult population in the United States has CKD at stages 1 and 2.

An additional 4.5% of the U.S. population is estimated to have stages 3 and 4 CKD

The most frequent cause of CKD in North America and Europe is diabetic nephropathy, most often secondary to type 2 diabetes mellitus

Etiologies

Patofisiologi initiating mechanisms specific to the

underlying etiology a set of progressive mechanisms, involving

hyperfiltration and hypertrophy of the remaining viable nephrons, that are a common consequence following long-term reduction of renal mass, irrespective of underlying etiology

Hipertofi dan hiperfiltrasi

Increase Renin and AT

Increase GFR

MaladaptationSklerosis nephron

Stimulated TGF-B

Decreased GRF

Renal failure

Harrison Principle of Internal Medicine 18

Clinical examination Hypertension Cardiovaskular abnormality Hematologi abnormality Gastrointestinal abnormality Neurology abnormality Metabolic asidosis

Diagnosis1.BUN Increase2.Creatinine Increase3.Anemia4.Metabolic Asidosis5.Hyperfosfatemia6.Hypokalsemia7.Hyperkalemia

Additional examination

Radiology BNOIVPUSGRenogramThorax photo

ECG Biopsy ginjal

LaboratoriumNormokrom normositer anemiaUreum and creatininHiponatremiaHiperkalemiaHiperfosfatemiaHipokalsemiaHipoalbumin and hiperkolesterolemiaMetabolic asidosis

Treatment Spesific therapy for etiologiesTo prevent renal failurePrevent and therapy for cardiovaskuler diseasePrevent and therapy for complicationHemodialisis

Complication Cardiovaskuler

hypertension perikarditis CHF

Acid base disorder Fluid and Elektrolit disorder Anemia

Life threating: Hiperkalemia (K>6,5 mE/l) Asidosis berat (pH<7,1) Azotemia (Ureum >200 mg/dl)

Ensefalopati uremikum Perikarditis uremik Neuropati/miopati uremik

Prevention

Controlling diabetes Controlling hypertension Controlling dislipidemia Controlling anemia Controlling hiperfosfatemia

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