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Indikasi Dialisis
ANATOMI Anatomy
• 2 Kidneys
• 2 Ureters
• Bladder
• Urethra
Kidney Function
• Detoxify blood
• Increase calcium absorption
calcitriol
• Stimulate RBC production
erythropoietin
• Regulate blood pressure and electrolyte
balance
renin
• Definisi
(NKF KDOQI guidelines, 2002)
KDIGO 2012
• CKD is defined as abnormalities of kidney
structure or function, present for > 3 months,
with implications for health
(NKF KDOQI guidelines, 2002)
• KLASIFIKASI
(NKF KDOQI guidelines, 2002)
KDIGO 2012
(CGA) Cause..
Major causes of chronic renal failure.
Glomerulopathies Tubulointerstitial nephritis
Drug hypersensitivity
• Primary glomerular diseases: Idiopathic
Heavy metals
1. Focal and segmental glomerulosclerosis Analgesic nephropathy
2. Membranoproliferative glomerulonephritis Reflux/chronic pyelonephritis
3. IgA nephropathy
4. Membranous nephropathy Hereditary diseases
Polycystic kidney disease
• Secondary glomerular diseases: Medullary cystic disease
Alport's syndrome
1. Diabetic nephropathy Obstructive nephropathies
2. Amyloidosis Prostatic disease
3. Postinfectious glomerulonephritis Nephrolithiasis
4. HIV-associated nephropathy Retroperitoneal fibrosis/tumor
5. Collagen-vascular diseases Congenital
6. Sickle cell nephropathy Vascular diseases
7. HIV-associated membranoproliferative Hypertensive nephrosclerosis
glomerulonephritis
Renal artery stenosis
(Tierney, et.al; 2006)
Penyebab terbanyak PGK
Drug (1.50%)
BATU GINJAL
(9.20%) Policystic kidney
(3.10%) Glumerulonefritis
Diabetes melitus
HIPERTENSI (22%) GN (45%)
Hipertensi
Batu ginjal
DM (20%) Polycystic kidney
Drug induce
•
• Fever Menstrual Renal disease other
• Urinary infection contamination than diabetes
• Significant physical activity
in the preceding 24 hours Vaginal
• Severe hypertension discharge
• Heart failure stage IV
• Preeclampsia
• Post surgery (major)
Highly unstable diabetes
B. Worsening of renal function with blood urea nitrogen exceeding 70-100 mg/dl or
decreased creatinine clearance <15-20 mL/min/1,73m2.
(Levy, et.al; 2009)
Indikasi Dialisis
Urgent Indications
• Neurologic dysfunction
(neuropathy, encephalopathy, psychiatric disturbance)
• Pleuritis or pericarditis without other explanation
• Bleeding diathesis manifested by prolonged bleeding time
a
Modified from the National Kidney Foundation's 2006 Kidney Disease Outcomes Quality Initiative (KDOQI) hemodialysis adequacy guidelines