Treatment for CKD Management of CRF include: 1.

Specific treatments against diseases basis (LFG 90 ml / min) The best time for treatment before the disease is essentially a reduction in LFG, thus worsening renal function was not occur. Conversely, if LFG has dropped to 20-30% of normal, therapy against basic diseases are not very useful. 2. Prevention and treatment of the comorbid condition (LFG 90 ml / min) comorbid factor can worsen the patient's condition. Comorbid factors, among others, fluid balance disorders, uncontrolled hypertension, urinary tract infection, nephrotoxic drugs, radiocontrast material, or an increase in disease activity base. 3. Slowing worsening (progression) renal function (LFG 60-89 ml / min) The main factors causing deterioration of renal function is the glomerular hyperfiltration. Two important ways to reduce glomerular hyperfiltration are: Restriction of protein intake. Restriction of protein intake began in LFG 60 ml / min, while above that value, restriction of protein intake is

not always advisable. Protein is given 0.6 to 0.8 / kg / day, which is 0.35 to 0.50 grams of which is a protein of high biological value. The number of calories given at 30-35 kcal / kg / day, which required regular monitoring of the patient's nutritional status. If there is malnutrition, calorie and protein intake can be increased. Unlike fats and carbohydrates, excess protein is not stored in the body but in the rupture in the form of urea and other nitrogen substances, which is mainly excreted via the kidneys. In addition, highprotein foods that contain hydrogen ions, phosphates, sulfates, and other inorganic ions are also excreted through the kidneys. Therefore, the provision of high-protein diet in patients with chronic kidney disease will lead to the accumulation of substances nitrogen and other inorganic ions, and the resulting disruption and metabolic klisnis called uremia. Controlling blood pressure will slow further kidney damage.

used most often. The goal is to keep blood pressure at or below 130/80 mmHg

Other tips for protecting the kidneys and preventing heart disease and stroke:

Do not smoke. Eat meals that are low in fat and cholesterol. Get regular exercise (talk to your doctor or nurse before starting to exercise). Take drugs to lower your cholesterol, if needed. Keep your blood sugar under control. Avoid eating too much salt or potassium.

Prognosis CKD Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function. Untreated, it usually worsens to endstage renal disease. Lifelong treatment may control the symptoms of chronic kidney disease.

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are

Possible Complications CKD

Anemia Bleeding from the stomach or intestines Bone, joint, and muscle pain Changes in blood sugar Damage to nerves of the legs and arms (peripheral neuropathy) Dementia Fluid buildup around the lungs (pleural effusion) Heart and blood vessel complications o Congestive heart failure o Coronary artery disease o High blood pressure o Pericarditis o Stroke High phosphorous levels High potassium levels Increased risk of infections Liver damage or failure Malnutrition Miscarriages and infertility Seizures Swelling (edema) Weakening of the bones and increased risk of fractures

Treatment for ARF Diuretics starting with the conventional dose of 40 mg iv, then if there is no response at high doses, 200 mg every 6 hours, then the infusion of 10-40 mg / hour . In the advanced stage if there is no response can be given furosemide in albumin administered intravenously over 30 minutes at the same dose or with HCT. Dialise or haemofiltration done if all the above measures fail to secrete fluid. Diuretics will only succeed if the ARF is still a pre-renal, renal ARF when it happens there is no response. Dialysis Dialysis can be done on the basis of: 1. Dialysis prevention Performed after the diagnosis is established NTA. Peritoneal dialysis is done 3 times a week and each time for 8 hours. 2. Dialysis on specific indications Absolute indication for dialysis is the presence of uremia syndrome and the presence of life-threatening emergencies that hypervolemia (pulmonary edema), hyperkalemia, or severe acidosis resistant to conservative treatment. If there is a continued

increase in blood urea and creatinine in patients with conservative treatment oliguric and no signs of improvement (increased urine production, urea and creatinine are stable or decreasing), then it is time to be considered for dialysis. Peritoneal dialysis or hemodialysis on indication: a. Clinical indications: mental status changes, stop urinating, pericarditis, retain too much fluid, cannot eliminate nitrogen waste products from your body b. Biochemical Indications: - U + blood> 200 mg% - HCO3 <16 mEq / L - Potassium> 7 mEq / L - PH <7.1 Supportive Therapy Excess intravascular volume - Limit salt (1-2 g / day) and water (less than 1 liter / day) - Furosemide, ultrafiltration or dialysis Hyponatremia - Limit intake of water (less than 1 liter / day), avoid hypotonic infusion Hyperkalemia

- Limit intake of dietary K (less than 40 mmol / day), avoid potassiumsparing diuretics - Potassium-binding ion exchange resins - Glucose (50 mldextrosa 50%) and insulin (10 units) - Sodium bicarbonate (50-100 mmol) - 2 agonists (salbutamol, inhaled or 10-20 mg 0.5-1 mg IV) - Calcium gluconate (10 ml solution of 10% within 2-5 minutes) Metabolic acidosis - Sodium bicarbonate (serum bicarbonate try more than 15 mmol / liter with a pH greater than 7.2) hyperphosphatemia - Limit intake of diet (less than 800 mg / day) - Drug phosphate binders (calcium acetate, calcium carbonate) Hypocalcaemia - Calcium carbonate, calcium glikonat (10-20 ml solution of 10%) Nutrition - Limit intake of dietary protein (0.8 to 1 g / kg bw / day) if not dalamkondisi catabolic - Carbohydrates (100 g / day) - Enteral or parenteral nutrition, if

traveling long clinic or catabolic Prognosis ARF Mortality in ARF patients approximately 50%. Patients usually die from the disease the primary cause and not the consequence of ARF ARF itself. Oliguria and increased serum creatinine more than 265 mol / l (more than 3 mg%) had a poor prognosis. The death rate is also increased in patients with multi-organ failure. Most of the ARF patients had improvement in kidney function can live normally. Approximately 5% of patients who did not experience improvement ARF kidney function requiring dialysis or transplantation long term to replace kidney function.