Acute Kidney Injury

Haidar Alatas

Gambaran Klinis GGA

HB normal
Oliguric type
Non oliguric type (30-60%)
prognosis lebih baik causa AB /
nephrotoxic agent
Umumnya reversible
Mortalitas tinggi: 40-60%
Frekuensi : 5-15% pasien rawat

Penyebab GGA
Pre-renal : Hypovolemic, hypotensi,
dehydrasi, syok
Renal (Intrinsic renal failure) ATN
(acute tubular nephrosis) or VMN
(vascular membrane nephrosis)
Post-renal : obstruksi, batu, prostat,
trauma, keganasan.

Anamnesis

Gastro Enteritis akut

Riwayat tindakan / operasi
Hipotensi shock
Hipertensi (accelerated / malignant)
Drugs
Renal disease
Acute on chronic

Gambaran klinik ARF

Onset Phase : oliguria, ureum
creatinin meningkat, gangguan
elektrolit
Oliguric Phase : fluid overload,
edema ankle/pulmo, hyperkalemia
cardiac, arythmia, hyponatremia,
acidosis, kussmaul respiration.

Gambaran klinik ARF

Diuretic Phase : restorasi fungsi
ginjal
1 hari s/d 2 minggu
Keseimbangan cairan, dehydrasi,
hypokalemia
Gejala-gejala hilang, nafsu makan pulih

Acute uremic syndrome

CVS : hipertensi, arythmia, CHF,
pericarditis
Gastroinstestinal : anorexia, nausea,
vomithing, diarhea, bleeding,
pancreatitis
CNS : cunfussion, twitching, asterixis,
soporosus coma
Hemopoetic system : bleeding,
anemia

Management of ARF
Phase oliguri : cairan <500 cc/h,
monitor elektrolit : kalium, asupan
kalori. Dialisis
Phase diuresis : keseimbangan cairan
dan elektrolit
Post diuresis : cairan / elektrolit
Prognosis : tergantung penyebab,
usia, comorbid, infeksi, multi organ

Penyakit apa saja penyebab

aki
(1). Penyakit yang menyebabkan hipoperfusi
pada ginjal tanpa kerusakan integritas dari
parenkim ginjal (GGA prerenal, prerenal
azotemia) (~55%).
(2) Penyakit yang secara langsung
melibatkan parenkim renal (GGA renal, renal
azotemia) (~40%).
(3) Penyakit yang berhubungan dengan
sumbatan pada saluran kemih (GGA
postrenal, postrenal azotemia) (~5%).

Prerenal Failure

Advanced heart disease with very low cardiac output

Systemic sepsis.
Extracellular volume depletion.
Acute blood loss following, for example, major trauma
or gastrointestinal or postpartum hemorrhage.
'Third space' fluid loss in patients with intestinal
obstruction or ileus
Severe burns
Hepatic failure may cause hepatorenal syndrome.
Medications, including angiotensin-converting enzyme
(ACE) inhibitors and renal vasoconstrictors, such as
cyclosporine.

Renal Failure
Administration of nephrotoxic drugs:
aminoglycoside.
Administration of radiographic
contrast media.
Acute glomerulonephritis.
Previous renal transplant with acute
or chronic rejection.
Systemic sepsis

Postrenal Failure

Renal calculi.
Benign prostatic hyperplasia.
Prostate cancer.
Bladder cancer.
Cervical cancer.
Posterior urethral valves: in young boys
Urethral stricture.
Retroperitoneal fibrosis: May cause bilateral
obstruction at any level of the ureters.

TERIMAKAS
IH