awam ggk (skm)
TRANSCRIPT
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Gagal Ginjal Kronik dengan Hemodialysis reguler
“Peranan pasien dan keluarga”
R Tunggul Sukendar
Divisi Ginjal dan HipertensiBagian Ilmu Penyakit Dalam FK USU/
RSUP H. Adam Malik Medan
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Mengenali Kelainan Ginjal
Ginjal ada 2 : kiri dan kananBerat masing-masing : 1/3 kgRenal blood flow : 1-1,5 L/menit
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Unit fungsional Ginjal : NefronJumlah : masing-masing : 1 juta
GlomerulusTubulus proximalLengkung HenleTubulus distalTubulus pengumpul
CalyxPyelumUreterKandung kemihUrethra
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RENAL CYSTIC DISEASE
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CHRONIC PYELONEPHRITIS
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Fungsi Ginjal
1. Fungsi EkskresiMeneluarkan zat toksis / racun
2. Fungsi Regulasi
Mengatur keseimbangan : air, garam/elektrolit Asam / Basa
3. Fungsi hormonalHormon renin, prostaglandinEritropoetin, Kalsitriol dll
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Gangguan Ginjal :
Akut : :
Tiba-tiba, dalam beberapa hari / minggu anuria / Oligouria ataupun tidakBila anuria / Oligouria terjadi Oedema, Hipertensi, sesak nafas, sindroma uremik : mual, muntah
Kronik : Terjadi penurunan fungsi ginjal perlahan selama berbulan ataupun bertahun. Awalnya tanpa gejala sampai fungsi ginjal < 25%.
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Seluruh organ dan sistem tubuh dikenai
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46-year-old kidney patient, was diagnosed With polycystic kidney disease 17 years ago andhas been on hemodialysis ever since.
“Dialysis does not mean stop living,”
says Melvin Bradford.” It means find a new to live.It means develop skills that are going to help you to live longer.”
Melvin
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Tujuan Pengobatan GGT:
Menurunkan mortalitas meningkatkan /memperpanjang lama hidup ( survival)
Memperbaiki kualitas hidup (QoL) Mengobati gejala/komplikasi kronik uremia Tindakan rehabilitasi
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Dialisis Peritoneal
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Kidney undergoing perfusion(in ice) after harvesting
Cooled kidney inSurgical gloves, ready For transplantation
Transplanted kidney afterremoval on clamps showing“pinking up” and urine formation
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How Often Is Enough ?
• Once Weekly ?
Can’t control K or volume
• Twice Weekly ?
Only if residual function
• Thrice weekly ?
Appears adequate
• Daily ?
Yet to be proven
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30
20
10
0
30
20
10
00 1 2 3 4 5 60 1 2 3 4 5 6
Time (days)Time (days)
Ure
a co
ncen
tratio
n(m
mol
/L)
Ure
a co
ncen
tratio
n(m
mol
/L)
HD1HD1 HD2HD2 HD3HD3
The discontinuous time course of serum urea concentration over one week with a thrice-
weekly dialysis schedule
The discontinuous time course of serum urea concentration over one week with a thrice-
weekly dialysis schedule
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Volume responses and enhanced frequency dialysis
Mon
TuesW
ed
Thurs FriSat
SunM
on
Vo
lum
e
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Slow Nocturnal Home hemodialysis :
6 x 8 jam (overnight) Dialysate flow : 300 ml/min Blood flow rate : 300 ml/min Hi flux membrane 2 x needles
No diet restrictionNo fluid restrictionNo BP tabletNo Phosphate binder
Kadang perlu penambahan PhosphateAtau Ca pada dialysat
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Slow Nocturnal Home Hemodialysis Slow Nocturnal Home Hemodialysis
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PPengaturan Nutrisi :
Target : Minimal uremik toksisiti Minimalisasi gangguan metabolisme (ca & P) ,
cairan dan elektrolit (K)
Mempertahankan status nutrisi yg baik gn makanan yg cukup menyenangkan (protein, kalori, vitamin dll)Protein
Garam dan airKalimCalsium dan Phosphat
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Protein :
Sumber protein :
Daging ayam, kalkun, ikan, daging segar yang tak berlemak. Merupakan protein lengkap
Dairy product : susu, keju, yogurt dan telur juga merupakan protein lengkap tetapi :
tinggi kolesterol, lemak dan Phosphat
Kacang-kacangan, jagung dan biji-bijian (padi, gandum) protein yg tdk lengkap
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Terlalu banyak protein :
Mual, muntah Lelah Bingung Kalium darah meningkat Lama HD akan meningkat
Terlalu sedikit protein :
Hilangnya massa otot Lelah BB berkurang Luka sulit sembuh
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Garam dan air
Target : Capai Berat badan Kering (Dry weight) Pertahankan BB antar dialyisis : 1.5 kg Batasi garam : 2-3 g/hari
Jangan tambahkan garam saat memasak Jangan letakkan garam di atas meja Waspadai garam yg tersembunyi di makanan :
Asinan (somboy, ikan asin, telur asin dll) makanan kaleng (corned, sardinnes) kecap, saus tomat dll
Jangan gunakan garam palsu (high K) Untuk memberi kenikmatan gunakan bahan pedas
dari tumbuhan alami
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Interdialytic Weight GainInterdialytic Weight Gain
1.5-2 kgUF rate rata-rata 2.0-2.5 kg0.5 kg : Cairan yg diminum + priming+flushing dll
Kerjasama yg baik dgn Dietitian
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1953
Northern Territories
80/40
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1997
Northern Territories
170/100
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Why did they Migrate ?
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Pressure is simple
V
MC Volume through the Pipes
Size of the Pipes
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Salt restriction and SR + enhanced UF
64.1 62.20
1020304050607080
Before Salt restriction only
(n=20)
After
Bo
dy
we
igh
t k
g
020406080100120140160180
BP
mm
Hg
BW SBP DBP
65.5 61.70
102030405060708090
Before Salt restriction plus UF
(n=17)
After
Bo
dy
we
igh
t k
g
020406080100120140160180200
BP
mm
Hg
BW SBP DBP
Salt restriction alone:20/47 = 43% success
Salt restriction + UF+:37/47 = 79% success
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Improved hypertension control
0
0.5
1
1.5
2
2.5
0 8 24
AN
tih
yp
erte
ns
ive
d
rug
s/d
ay
40
60
80
100
120
140
160
180
Blo
od
pre
ssu
re m
mH
g
AHTN SBP DBP
Kooistra MP et al Nephrol Dial Transplant 1998; 13: 2853-2860
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Udema paru
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Kalium
Kalium tinggi : denyut jantung tak teratur dapat berhenti tiba-tiba
Makanan tinggi Kalium :kentang, labu, coklat, pisang, alpokat, jamur, jeruk,Pasta tomat, sayuran, buah kering, high fibre breakfastCereal dll
Bila sayuran tinggi KPotong kecil-kecil, masak dan tiriskan
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This fruits should be avoided
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This fruits are recommended
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Ca dan Posphat
Batasi : Susu Keju Yougurt
Ice cream Coklat Beer Firm Tofu
Hindarkan : Minuman Cola Daging asap Kacang-kacangan Whole grain cereal
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Makan pengikat Phosphat saat/bersamaan makanEfek samping : Sulit buang air besar
(makan makanan serat tinggi)
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Tumoral CalcinosisTumoral Calcinosis
• 1-2 months decrease in size• 8-9 months reabsorbed
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Koreksi anemia
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