Академический Документы
Профессиональный Документы
Культура Документы
gangguan fungsi ginjal yang menahun bersifat progresif dan irreversibel. Dimana
kemampuan tubuh gagal untuk mempertahankan metabolisme dan keseimbangan
cairan dan elektrolit serta menyebabkan uremia (retensi urea dan sampah nitrogen lain
dalam darah)
suatu keadaan klinis yang ditandai dengan penurunan fungsi ginjal yang bisa dilihat
dari penurunan GFR yaitu < 60 mL/min/1.73 m2 atau adanya bukti dari kerusakan
ginjal termasuk albuminuria persisten yaitu > 30 mg albumin urin per creatinine urin.1
The term chronic renal failure applies to the process of continuing significant
irreversible reduction in nephron number and typically corresponds to CKD stages 3
5. The pathophysiologic processes and adaptations associated with chronic renal
failure will be the focus of this chapter. The dispiriting term end-stage renal disease
represents a stage of CKD where the accumulation of toxins, fluid, and electrolytes
normally excreted by the kidneys results in the uremic syndrome. This syndrome leads
to death unless the toxins are removed by renal replacement therapy, using dialysis or
kidney transplantation. These latter interventions are discussed in Chaps. 281 and 282.
End-stage renal disease will be supplanted in this chapter by the term stage 5 CKD.
(horison)
Stage Description
GFR
(mL/min/1.73
m2)
4
5
GFR
90
Action3
GFR
Moderately
GFR
Severely
GFR
Kidney failure
3059
1529
Glomerulopathies
Primary glomerular diseases:
Focal and segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
IgA nephropathy
Membranous nephropathy
Secondary glomerular diseases:
Diabetic nephropathy
Amyloidosis
Postinfectious glomerulonephritis
HIV-associated nephropathy
Collagen-vascular diseases
Sickle cell nephropathy
HIV-associated membranoproliferative glomerulonephritis
Tubulointerstitial nephritis
Drug hypersensitivity
Heavy metals
Analgesic nephropathy
Reflux/chronic pyelonephritis
Idiopathic
Hereditary diseases
Polycystic kidney disease
Medullary cystic disease
Alport syndrome
Obstructive nephropathies
Prostatic disease
Nephrolithiasis
Retroperitoneal fibrosis/tumor
Congenital
Vascular diseases
Hypertensive nephrosclerosis
Renal artery stenosis
Glomerulonefritis (46,39%)
2.
3.
4.
Hipertensi (8,46%)
5.
Penyebab penyakit ginjal kronik cukup banyak tetapi untuk keperluan klinis dapat dibagi
dalam 2 kelompok : 3,4
1. Penyakit parenkim ginjal
Penyakit ginjal primer : glomerulonefritis, myelonefritis, ginjal polikistik, tbc ginjal
Penyakit ginjal sekunder : nefritis lupus, nefropati, amilordosis ginjal, poliarteritis
nodasa, sclerosis sistemik progresif, gout dan diabetes melitus
2. Penyakit ginjal obstruktif (pembesaran prostat, batu saluran kemih, refluks ureter)
Signs
General
Fatigue, weakness
Skin
ENT
Urinous breath
Eye
Pulmonary
Pale conjunctiva
Shortness of breath
Nocturia, impotence
Isosthenuria
On physical examination, the patient appears chronically ill. Hypertension is common. The
skin may be yellow, with signs of easy bruisability. Rarely seen in the dialysis era is uremic
frost, a cutaneous reflection of ESRD. Uremic fetor is the characteristic fishy odor of the
breath. Cardiopulmonary signs may include rales, cardiomegaly, edema, and a pericardial
friction rub. Mental status can vary from decreased concentration to confusion, stupor, and
coma. Myoclonus and asterixis are additional signs of uremic effects on the central nervous
system.
The term "uremia" is used for this clinical syndrome, but the exact cause remains unknown.
BUN and serum creatinine are considered markers for unknown toxins.
In any patient with renal failure, it is important to identify and correct all possibly reversible
causes. Urinary tract infections, obstruction, extracellular fluid volume depletion,
nephrotoxins, hypertension, and congestive heart failure should be excluded (Table 228).
Any of the above can worsen underlying chronic renal failure
Imaging
The finding of small echogenic kidneys bilaterally (< 10 cm) by ultrasonography supports a
diagnosis of chronic kidney disease, though normal or even large kidneys can be seen with
chronic renal failure caused by adult polycystic kidney disease, diabetic nephropathy, HIVassociated nephropathy, multiple myeloma, amyloidosis, and obstructive uropathy.
Radiologic evidence of renal osteodystrophy is another helpful finding, since radiographic
changes of secondary hyperparathyroidism do not appear unless parathyroid levels have been
elevated for at least 1 year. Evidence of subperiosteal reabsorption along the radial sides of
the digital bones of the hand confirms hyperparathyroidism.