ACUTE KIDNEY

INJURY (AKI)
Muhamad Irfanny
16-146
 Definisi

AKI is a condition in which the glomerular filtration rate is abruptly reduced,

causing a sudden retention of endogenous and exogenous metabolites (urea,
potassium, phosphate, sulfate, creatinine, administered drugs) that are normally
cleared by the kidneys. The urine volume is usually low (<400 mL/ day).

Acute kidney injury (AKI) merupakan suatu sindrom yang ditandai dengan
gangguan fungsi ginjal dalam mengatur komposisi cairan dan elektrolit tubuh,
serta pengeluaran produk sisa metabolisme, yang terjadi tiba-tiba dan cepat.
 Epidemiologi
■ Penelitian meta-analisis mencakup 154 studi pada lebih dari 3.000.000
individu menyatakan bahwa 1 dari 5 orang dewasa dan 1 dari 3 anak di seluruh
dunia mengalami AKI selama perawatan di rumah sakit.
■ Insidens AKI pada pasien yang dirawat di ruang perawatan intensif (ICU) adalah
sekitar 20-50%. Sepsis dan syok sepsis merupakan presipitan utama AKI. AKI
pada syok septik meningkatkan morbiditas dan mortalitas
■ Many etiologies for AKI are region specifi c such as envenomations from snakes,
spiders, caterpillars, and bees; infectious causes such as malaria and
leptospirosis; and crush injuries and resultant rhabdomyolysis from earthquakes

http://www.kalbemed.com/Portals/6/1_21_259Opini-
Wireless%20Microcurrent%20Stimulation%20Therapy%20for%20Wound%20Healing.pdf

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

 Etiologi
Prerenal
• a decrease in GFR due to a decrease in
renal perfusion pressure without
damage to the renal parenchyma

Oxford Textbook of Clinical Nephrology 4th ed

Osmosis
 Etiologi
Intrarenal
• damage to the four major structures of the
kidney. These four structures are 1) the tubules,
2) the glomeruli, 3) the interstitium, and 4) the
intrarenal blood vessels

Oxford Textbook of Clinical Nephrology 4th ed

 Etiologi
Intrarenal
• damage to the four major structures of
the kidney. These four structures are 1)
the tubules, 2) the glomeruli, 3) the
interstitium, and 4) the intrarenal blood
vessels

Renal Pathophysiology The Essentials 4th ed

Harrison’s Nephrology and Acid-
Base Disorders, 2nd ed
Osmosis
Osmosis
 Etiologi
Postrenal
• acute obstruction to urinary flow. Urinary
tract obstruction increases intratubular
pressure and thus decreases GFR

Oxford Textbook of Clinical Nephrology 4th ed

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed
Osmosis
Harrison’s Nephrology and Acid-Base Disorders, 2nd ed
Klasifikasi https://www.ajkd.org/article/S0272-6386(17)31141-1/fulltext
Klasifikasi http://www.kalbemed.com/Portals/6/1_21_259Opini-
Wireless%20Microcurrent%20Stimulation%20Therapy%20for%20Wound%20Healing.pdf
Klasifikasi
http://www.kalbemed.com/Portals/6/1_21_259Opini-
Wireless%20Microcurrent%20Stimulation%20Therapy%20for%20Wound%20Healing.pdf
Gejala Klinis & Diagnosis

Osmosis
Gejala Klinis & Diagnosis

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

Gejala Klinis & Diagnosis

Osmosis
Gejala Klinis & Diagnosis

Osmosis
Gejala Klinis & Diagnosis Harrison’s Nephrology and Acid-Base
Disorders, 2nd ed
Gejala Klinis & Diagnosis

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

Gejala Klinis & Diagnosis

Osmosis
Gejala Klinis & Diagnosis

Osmosis
Gejala Klinis & Diagnosis

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

 Alur Diagnosis

https://www.aafp.org/afp/2012/1
001/p631.html
Komplikasi
■ Uremia
■ Hiponatremia
■ Hiperkalemia
■ Asidosis metabolic
■ Hiperfosfatemia dan Hipokalsemia
■ Perdarahan
■ Infeksi
■ Jantung (aritmia, pericarditis, efusi pericardium)
■ Malnutrisi

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

 Alur Tata
Laksana

https://www.ajkd.org/article
/S0272-6386(17)31141-
1/fulltext
Tata Laksana
Tujuan pengelolaan AKI yang utama adalah mencegah kerusakan ginjal lebih lanjut dan
mempertahankan pasien tetap hidup sampai faal ginjalnya kembali ke fungsi normal

http://www.kalbemed.com/Portal
s/6/1_21_259Opini-
Wireless%20Microcurrent%20Sti
mulation%20Therapy%20for%20
Wound%20Healing.pdf
 Tata
Laksana
Tujuan terapi konservatif :
mencegah atau mengurangi
progresivitas penurunan fungsi
ginjal, morbiditas, dan mortalitas
akibat komplikasi AKI. Jika terapi
konservatif gagal mengatasi segala
komplikasi AKI, perlu
dipertimbangkan RRT (dialisis)

http://www.kalbemed.com/Portal
s/6/1_21_259Opini-
Wireless%20Microcurrent%20Sti
mulation%20Therapy%20for%20
Wound%20Healing.pdf
Tata Laksana
Kriteria RRT (hemodialisis) pada pasien kritis dengan AKI :
1. Oliguria: produksi urin <200 mL dalam 12 jam
2. Anuria: produksi urin <50 mL dalam 12 jam
3. Hiperkalemia: kadar potassium >6,5 mmol/L
4. Asidemia yang berat, pH <7,0
5. Azotemia: kadar urea >30 mmol/L
6. Ensefalopati uremikum
7. Neuropati/miopati uremikum
8. Perikarditis uremikum
9. Abnormalitas natrium plasma >155 mmol/L atau <120 mmol/L
10. Hipertermia http://www.kalbemed.com/Portal
s/6/1_21_259Opini-
11. Keracunan obat Wireless%20Microcurrent%20Sti
mulation%20Therapy%20for%20
Wound%20Healing.pdf
Prognosis
■ Prerenal azotemia, with the exception of the cardiorenal and
hepatorenal syndromes, and postrenal azotemia carry a better
prognosis than most cases of intrinsic AKI
■ Survivors of an episode of AKI requiring temporary dialysis, however,
are at extremely high risk for progressive CKD, and up to 10% may
develop end-stage renal disease

Harrison’s Nephrology and Acid-Base Disorders, 2nd ed

 Referensi
■ Jameson, J Larry et al. 2013. Harrison’s Nephrology and Acid-Base Disorders.
2nd ed. US : Mc-Graw Hill Education
■ Rennke, G Helmut et al. 2014. Renal Pathophysiology The Essentials. 4th ed.
Philadelphia : Lippinott Williams & Wilkins
■ Turner, Neil et al. 2016. Oxford Textbook of Clinical Nephrology. 4th ed. UK :
Oxford University Press
■ https://www.aafp.org/afp/2012/1001/p631.html
■ https://www.ajkd.org/article/S0272-6386(17)31141-1/fulltext
■ http://www.kalbemed.com/Portals/6/1_21_259Opini-
Wireless%20Microcurrent%20Stimulation%20Therapy%20for%20Wound%20He
aling.pdf