PENYAKIT GINJAL

KHRONIK

SYAIFUL AZMI
SUB BAGIAN GINJAL HIPERTENSI BAGIAN ILMU PENYAKIT DALAM
RSUP Dr M DJAMIL / FAK. KEDOKTERAN UNIV. ANDALAS
PADANG

GINJAL

GINJAL : ORGAN VITAL

TIDAK BERFUNGSI MATI 3 4 MINGGU
BENTUK SEPERTI KACANG
LETAK : KEDUA SISI TULANG BELAKANG

SETINGGI PINGGANG
- UKURAN : 11.25 X5 X 2.5 Cm.
- BERAT : 120 175 Gr

ALIRAN DARAH GINJAL

20 25 % DARAH YANG DIPOMPA JANTUNG
GINJAL ( RENAL BLOOD FLOW )
1.200 1.300 CC/MENIT

125 -150 CC/MENIT DISARING OLEH GINJAL

( LAJU FILTRASI GLOMERULUS = LFG )

Ginjal

Nefron

Juxtaglomerular Apparatus

BAGAIMANA GINJAL BEKERJA

LFG : 125 150 CC/MENIT
DISARING OLEH GINJAL, PRODUK
YANG TIDAK BERGUNA DAN AIR YANG
BERLEBIH DIBUANG OLEH GINJAL

10

FUNGSI UTAMA GINJAL

1. MEMBUANG PRODUK YANG TIDAK BERGUNA
- UREUM
- KREATIN

2. MENGATUR CAIRAN TUBUH

- KELEBIHAN CAIRAN URINE BANYAK
- KEKURANGAN CAIRAN URINE SEDIKIT
3. MENGATUR TEKANAN DARAH

4. FASILITATOR PEMBENTUKAN SEL DARAH MERAH

- GINJAL MENGHASILKAN HORMON ERITROPOITIN YANG
MEMBANTU PRODUKSI SEL DARAH MERAH
5. MEMELIHARA KESEHATAN TULANG
- GINJAL MENGATUR KESEIMBANGAN FOSFOR DAN
KALSIUM

PENYAKIT GINJAL KRONIS

KEMARAHAN MENYERTAIKU KETIKA AKU DIBERITAHU

MENDERITA GAGAL GINJAL. AKU MARAH PADA DIRI SENDIRI,
KELUARGAKU, DOKTERKU DAN DUNIA. AKU AKAN
MENUNJUKKAN PADA MEREKA TIDAK ADA YANG SALAH
DENGANKU, AKU AKAN BERTANGGUNG JAWAB PADA
HIDUPKU .. ANTO.

BERHARI HARI AKU BINGUNG, AKU BERPIKIR MUNGKIN

DOKTER TELAH MEMBUAT KESALAHAN, MUNGKIN AKU AKAN
SEMBUH SENDIRI . YANTI.

MUSTAHIL, BUKAN AKU, ADALAH REAKSIKU SEGERA KETIKA

DOKTER MEMBERI TAHU BAHWA AKU MENDERITA GAGAL
GINJAL PRAPTO.

PENYAKIT GINJAL KRONIS

KERUSAKAN GINJAL 3 BULAN
DENGAN ATAU TANPA
PENURUNAN LFG.
LFG < 60 ML / MENIT SELAMA
3 BULAN

KLASIFIKAS

PGK

STADIUM

LFG ML / MEN

TERAPI

90

KONSERVATIF,
KENDALIKAN FK RISIKO

60 - 89

IDEM

30 - 59

IDEM

15 - 29

IDEM

< 15

TERAPI PENGGANTI

TERAPI PENGGANTI
GINJAL
DIALISIS : - HEMODIALISIS
- PERITONIAL
DIALISIS
-CAPD
-APD
CANGKOK GINJAL

PENYEBAB

PGK

DIABETES MELITUS
HIPERTENSI
INFEKSI SALURAN KEMIH
SUMBATAN SALURAN KEMIH ( BATU )
GLOMERULONEFRITIS
KISTA GINJAL
LUPUS
GAGAL GINJAL AKUT
DLL

APA YANG TERJADI PADA

PGK
SISA PRODUK YANG HARUS
DIBUANG MENUMPUK
KELEBIHAN CAIRAN
ANEMIA
KEROPOS TULANG

GEJALA P G K
SISTEM PENCERNAAN
- MUAL, MUNTAH, KEMBUNG DAN
NAFSU MAKAN MENURUN
- NAFAS BAU KENCING, RASA TAK
ENAK PADA MULUT
- CEGUKAN
- GASTRITIS

GEJALA P G K
KULIT
- PUCAT, KUNING, KASAR DAN
KERING
- GATAL GATAL
- EKIMOSIS
- BEKAS GARUTAN

GEJALA P G K
DARAH
- ANEMIA - ERITROPOITIN MENURUN
- HEMOLISIS
- KEKURANGAN ZAT BESI
- PERDARAHAN SALURAN CERNA
- FIBROSIS SUM SUM TULANG
- TROMBOSIT MENURUN
PERDARAHAN

GEJALA P G K
SARAF OTOT
- PEGAL TUNGKAI
- KESEMUTAN
- LEMAH
- TIDAK BISA TIDUR
- GANGGUAN KONSENTRASI
- TREMOR
- KEJANG

GEJALA P G K
JANTUNG DAN PEMBULUH DARAH
-

HIPERTENSI
NYERI DADA
SESAK NAFAS, PAYAH JANTUNG
GANGGUAN IRAMA ( BERDEBAR )
EDEM / BENDUNGAN PARU

GEJALA P G K
ENDOKRIN
- GANGGUAN SEKSUAL
- DIABETES

GEJALA P G K
LAIN LAIN
- KEROPOS TULANG
- ASIDOSIS
- HIPERKALEMIA

PEMERIKSAAN
PENUNJANG
DARAH DAN URINE RUTIN
UREUM DAN KREATININ
L F G ( = TINGKAT KEBERSIHAN KREATININ )
= 140 UMUR (TH) x BB (KG)
0.72 x KREATININ DARAH
= WANITA : x 0.85
=UxV
P

U = KREATININ URINE
V = JUMLAH URINE/MENIT
P = KREATININ DARAH

PEMERIKSAAN
RADIOLOGI

BNO/IVP
USG
RENOGRAM
RPG
SISTOSKOPI

PROGNOSIS

IREVERSIBLE

CAPD = DPMB
CONTINOUS AMBULATORY PERITONIAL DIALYSIS
DIALISIS PERITONIAL MANDIRI BERKESINAMBUNGAN

SYAIFUL AZMI
SUB BAGIAN GINJAL HIPERTENSI BAGIAN
ILMU PENYAKIT DALAM FAK.KEDOKTERAN
UNIV. ANDALAS / RSUP Dr M DJAMIL
PADANG

TERAPI PENGGANTI
GINJAL
BILA TKK / LFG < 15 CC/MENIT
ADA 2 JENIS
- DIALISIS : - HEMODIALISIS
- PERITONIAL DIALISIS
-CAPD
-APD
- CANGKOK GINJAL

Terapi Pengganti Ginjal

Terintegrasi

Terapi
Pengganti
Ginjal

HD

CAPD

Transpla

Who Should Do Peritoneal

Dialysis?
ANY PATIENT WHO WANTS TO DO IT
(as long as there are no medical contra-indications
to peritoneal dialysis)
The only absolute contra-indications to PD:
Absence of peritoneal cavity that would
permit effective PD
Lack of permanent residence

INDIKASI CAPD

DIABETES MELITUS
PENYAKIT JANTUNG
STROKE
SUKAR MEMBUAT AKSES VASKULER
ANAK DAN MANULA
KOMPLIKASI DENGAN HD
JAUH DARI PUSAT HD
SERING BEPERGIAN JAUH DR PUSAT HD
KEMAUAN SENDIRI

Prevalence Rate (PR) of dialysis pts

in Indonesia at 1993

Not enough HD machines

Population HD patients

No of machines

ASKES
ASKES

16 million

3200 pts

530 HD machines

GAKIN
GAKIN

60 million

12.000 pts

2000 HD machne

Need 2000 machines

NOT ENOUGH MACHINE

Solution
Solution??
CAPD
CAPD

INCREASE OF DIALISYS Pts (YEAR 1989

1999)

H D PD
a m CA
r
og ram
r
P og
Pr

Th.1997
krisis
ekonomi

Hemodialysis cost can be reduced by re-using the dia

Is not the case in CAPD

CAPD patients Source

SOURCE NEW PATIENTS
NEW PATIENTS
CKD patient

HD UNITS

CAPD

Need
infrastructure
Pts attached
To HD Unit

UNITS
Need
training

CHANGE
CHANGE

Not attached
to HD Unit

How expensive is CAPD

(in Indonesia)
ASKES
PD transfer set

Cost sharing
Rp 1.130.000

Surgery
Dianeal

?
90 set

Dianeal 120 set

Rp.0
?

Rp. 3.100.000

Rp.0

Rp.4.133.000

Rp.1.033.

CAPD untuk swasta

= PD transfer set ( Rp. 2.200.000)

Dianeal 120 set ( Rp. 5.500.000)

RENCANA PEMERINTAH UNTUK

MENANGGUNG DIALISIS UNTUK GAKIN
PENDUDUK
INDONESIA
PT. ASKES
PERUSAHAAN

GAKIN
Populasi
yg
Ditangg

230 JUTA
15 JUTA
5 JUTA
60 JUTA
20 JUTA
80 JUTA

Perbandingan harga CAPD dan HD

(PT ASKES)
Hemodialysis
(ACETATE)

CAPD

Rp.377.000/kali
Harga/Bula
n
Rp.3.016..000 / 8 kali
PT
ASKES

SWASTA

Rp.3.120..000/ 90 set

Rp.4.254..000/12 kali

Rp.4.133..000/120 se

Rp.6.000.000/8 kali

Rp.5.500.000/120 set

Application of Peritoneal Dialysis in the world

Source: Ram Gokal, CAPD Overview : Advances in zPD, Vol 16, Supp 1, 1995

The introduction of
Continuous Ambulatory Peritoneal Dialysis
(CAPD) in Asia

Popovich & Moncrief

Singapore
Malaysia
Hong Kong
Korea
Thailand
Taiwan
Japan
The Philippines
Indonesia

1975
1979
1980
1980
1980
1982
1984
1984
1984
1984

The distribution of CAPD patients in Indonesia

By courtesy of Baxter-kalbe

Principle of CAPD
Dialysis solution is run in and left in
the abdominal cavity for about 4 6
hours during day, abd 8 to 12 hours
at night, 4 times a day
The process is continuous so as to
achieve adequate dialysis
Does not need a machine. Patient
dialysis himself day and night

Principle of CAPD
Efficiency of the process as judged
by removal of waste products is poor
but the quality of life enjoyed by the
patient is good
With CAPD the blood concentration of
wastes remain virtually constant

Principles of peritoneal dialysis. In the three pore model of

peritoneal transport (a), the smallest pores probably represent
aquaporins. Diffusion from capillaries into the peritoneal cavity
(b) depends on the intrinsic permeability of capillaries and also
on the number of perfused capillaries (the effective surface area)

Principles of peritoneal dialysis. In the three pore model of

peritoneal transport (a), the smallest pores probably represent
aquaporins. Diffusion from capillaries into the peritoneal cavity
(b) depends on the intrinsic permeability of capillaries and also
on the number of perfused capillaries (the effective surface area)

Faktor Catheter
Ujung Catheter yang idealis terletak di
pelvis minor

Technique of CAPD
The CAPD system is connected
to a transfer set which in turn is
connected to peritoneal catheter
with a titanium connector
The connection is made under
sterile conditions
Very careful instructions are given
to the patient when he trains for
CAPD
Importance of sterile technique is
emphasized because there is always
a risk of introducing bacteria into
the line which will result in
peritonitis

Technique of CAPD
The peritoneal dialysis solution bag
is then hung above the patient and
the drainage bag is placed below
patients abdomen
The patient starts with draining his
peritoneal cavity which had earlier
instilled with dialysis solution
Once the dialysate has drained out
of the abdomen, the new solution
is then instilled. Normally filling in
takes about 10 minutes

Technique of CAPD
Then the CAPD system is
disconnected and discard. The
transfer set is capped up with a
mini cap
For the next 4-8 hours, patient
goes on his business as usual
Then prepares to change to a
fresh solution bag. Changing of
spent dialysate for a fresh one
is known as the exchange
procedure
CAPD patients need to do 4
bags exchanges a day

Technique of CAPD
The patient will be trained to do
his dialysis at home
It is seen that CAPD is simple
but requires careful attention to
detail
Once established back at home
a CAPD patient is not forgotten.
CAPD nurse may visit or call.
Regular check-ups at CAPD
clinic are necessary:

To
To
To
To

discuss progress
have blood tests
talk about dietary difficulties
chat with other CAPD patients