PATHOFISHIOLOGIS CHRONIC KIDNEY DISEASE

A. DEFINITION

CKD is a kidney disease that can not be recovered or completely healed back to normal.
CKD is end stage renal disease who can are due to a variety of things. Where the ability of
the body fails to maintain fluid balance and electrolyte metabolism, leading to urem.

B. STAGES OF DISEASE CKD

According Suwitra (2006) and Kydney Organizazion (2007) stages CKD can be shown on
the glomerular filtration rate (GFR), is as the following:

1. Phase I is kidney damage with normal GFR atatu increased> 90 ml / min / 1.73 m 2
2. Phase II is kidney damage with mild decrease in GFR is 60-89 ml / min / 1.73 m 2
3. Phase III is kidney damage with decreased GFR being is 30-59 ml / min / 1.73 m 2
4. Stage IV is kidney damage with LFG weight reduction is 15 to 29 ml / min / 1.73 m 2
5. Stage V is kidney failure with GFR <15 ml / min / 1.73 m 2

C. ANATOMY OF KIDNEY
Kidneys are excretory organs that play an important role in maintaining internal balance by
maintaining the composition of body fluids / ekstrasesular. The kidneys are two bean-shaped
organs bluish red colored pods. The kidneys are located on the posterior abdominal wall.
Covered kidney capsule of fibrous tunica strong and Kidney consists of the inside, (medulla),
the outer part (cortex).

As renal excretory systems work as filtran compounds that are no longer needed by the body
such as urea, sodium and others in the form of urine, the kidneys also function as forming
urine. In addition to the kidney as well as the exclusion of non ekresi system and work as
acid-base balance, fluid and electrolyte body and hormonal function. The kidneys secrete a
hormone called renin, which has a role in regulating blood pressure (renin-angiotensin-
aldosterone system), a regulator of erythropoiesis as hormone hormone activators 12 bone
marrow to produce red cells. Besides, the kidneys also distribute dihydroxy hormone
kolekalsi Feron (active vitamin D), which is required in the intestinal absorption of calcium
ions.
Here are some of the causes of CKD according to Price, and Wilson (2006) which are tubule
intestinal inflammatory disease, hypertensive vascular disease, connective tissue disorders,
congenital and hereditary disorders, metabolic diseases, toxic nephropathy, nephropathy
obsruktif. Some examples of classes of the disease are:

1. Tubulointerstinal Infectious diseases such as chronic nephritis pielo and reflux

nephropathy.
2. Inflammatory diseases such as chronic glomerulonephritis that renal impairment
after acute glomerulonephritis can develop slowly over a period of 5-20 years and
eventually
become chronic renal failure.
3. Vascular diseases such as hypertension, Nephrosclerosis benign, malignant
Nephrosclerosis, and renal artery stenosis.
4. Connective tissue disorders such as systemic lupus erythematosus, polyarteritis
nodosa, and progressive systemic seklerosis.
5. Congenital and Hereditary Disorders such as polycystic kidney disease, and renal
tubular acidosis.
6. Metabolic diseases such as diabetes mellitus, gout, and hyperparathyroidism, and
amyloidosis.
7. Nephropathy toxic as analgesic abuse, and lead nephropathy.
8. Obstructive nephropathy as the upper urinary tract consisting of the stones,
neoplasms, retroperitoneal fibrosis. Lower urinary tract consisting of hypertrophy of
the prostate, urethra setriktur, congenital anomalies bladder neck and urethra.

D. PATHOFISHIOLOGIS
According to Smeltzer and Bare (2001) the occurrence of CKD is a result of a decline in
renal function, the end product of protein metabolism which is normally excreted into the
urine accumulate in the blood, causing uremia that affects the body's systems. More and more
piles of garbage product, then any symptoms increased. Causing disruption renal clearance.
Many problems in the kidney as a result of a decrease in the number of functioning
glomeruli, causing a decrease in blood subtsansi clearance which should be cleared by the
kidneys.
Reduced glomerular filtration rate (GFR), can be detected by obtaining a 24-hour urine for
creatinine clearance checks. Decline in filtration glomelurus or malfunction due glomeluri
creatinine clearance. So that serum creatinine levels will increase in addition, levels of blood
urea nitrogen (nud) usually increases. Serum creatinine is the most sensitive indicator of renal
function due to this substance constantly produced by the body. Nud is affected not only the
final stage renal olehpenyakit, but also by the input of protein in the diet, and medications
such as steroids catabolism.
Reduced glomerular filtration rate (GFR) also affects the fluid and sodium retention. Fluid
and sodium retention is not controlled because the kidneys are unable to concentrate or dilute
the urine is normal in end-stage renal disease, renal appropriate response to changes in fluid
intake and electrolyte does not happen everyday. Sodium and fluid often retained in the body
that increases the risk of edema, congestive heart failure, and hypertension. Hypertension can
also occur due to activation of the renin-angiotensin axis and cooperation both increase the
secretion of aldosterone. Other patients have a tendency to lose salt, triggering the risk of
hypotension and hypovolemia. Episodes of vomiting and diareenyebabkan water and sodium
depletion, which increasingly memperburukstatus uremic. Metabolic acidosis occurs as a
result of the inability of the kidneys to secrete acid load (H +) is excessive. Acid secretion is
mainly due to the inability of the kidney tubules to secrete ammonia (NH3) and absorption of
sodium bicarbonate (HCO 3).
Decreased secretion of phosphate and other organic acids also occur. Kidney damage in CKD
also cause produksieritropoetin decreased and anemia occurs with shortness of breath, angina
and keletian. Inadequate erythropoietin may shorten the age of red blood cells, nutritional
deficiency and tendency to bleed because status of patients, especially from the
gastrointestinal tract resulting in severe or moderate anemia. Eritropoitin itself is a substance
normally produced by the kidneys to stimulate the bone marrow to produce red blood cells.
The other major abnormalities in CKD according Smeltzer and Bare (2001) is a disorder of
the body's metabolism of calcium and phosphate that have reciprocal relationship, if one
increases the other decreases. LFG decline causes an increase in serum phosphate levels and
conversely decreased serum levels causes a decrease in the secretion of parathormone of the
parathyroid gland. But in CKD, the body does not respond normally to increased secretion of
parathormone, and consequently decreased calcium in the bones, causing changes in the
bones and cause bone disease, in addition to the metabolically active vitamin D (1,25
dihidrokolekalsiferol) are normally made in the kidneys decreases, along with the
development of CKD occurs uremic bone disease and is often called Osteodistrofienal.
Osteodistrofienal happen of change complex of calcium, phosphate and parathormone
balance. The rate of decline in kidney function is also associated with underlying disorders
and urinary protein expenditure, and the presence of hypertension. Patients who excrete
significant number of proteins or increased blood pressure tends to be rapidly deteriorating
than those who did not experience this condition.

Nama Kelompok :

 Lusi Runtuwene (J210144006)

 Sabila Rizki (J210144007)
 Reni Octavia (J210144008)
 Winda Gustina (J210144009)
 Nisa Aisah Murti (J210144011)