ckd
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CHRONIC KIDNEY DISEASE
Putu Gede Ary Sanjaya
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Introduction
Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR)
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Epidemiology It has been estimated from population
survey data that at least 6% of the adult population in the United States has CKD at stages 1 and 2.
An additional 4.5% of the U.S. population is estimated to have stages 3 and 4 CKD
The most frequent cause of CKD in North America and Europe is diabetic nephropathy, most often secondary to type 2 diabetes mellitus
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Etiologies
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Patofisiologi initiating mechanisms specific to the
underlying etiology a set of progressive mechanisms, involving
hyperfiltration and hypertrophy of the remaining viable nephrons, that are a common consequence following long-term reduction of renal mass, irrespective of underlying etiology
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Hipertofi dan hiperfiltrasi
Increase Renin and AT
Increase GFR
MaladaptationSklerosis nephron
Stimulated TGF-B
Decreased GRF
Renal failure
Harrison Principle of Internal Medicine 18
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Clinical examination Hypertension Cardiovaskular abnormality Hematologi abnormality Gastrointestinal abnormality Neurology abnormality Metabolic asidosis
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Diagnosis1.BUN Increase2.Creatinine Increase3.Anemia4.Metabolic Asidosis5.Hyperfosfatemia6.Hypokalsemia7.Hyperkalemia
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Additional examination
Radiology BNOIVPUSGRenogramThorax photo
ECG Biopsy ginjal
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LaboratoriumNormokrom normositer anemiaUreum and creatininHiponatremiaHiperkalemiaHiperfosfatemiaHipokalsemiaHipoalbumin and hiperkolesterolemiaMetabolic asidosis
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Treatment Spesific therapy for etiologiesTo prevent renal failurePrevent and therapy for cardiovaskuler diseasePrevent and therapy for complicationHemodialisis
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Complication Cardiovaskuler
hypertension perikarditis CHF
Acid base disorder Fluid and Elektrolit disorder Anemia
Life threating: Hiperkalemia (K>6,5 mE/l) Asidosis berat (pH<7,1) Azotemia (Ureum >200 mg/dl)
Ensefalopati uremikum Perikarditis uremik Neuropati/miopati uremik
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Prevention
Controlling diabetes Controlling hypertension Controlling dislipidemia Controlling anemia Controlling hiperfosfatemia
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THANKYOU