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Acute Renal Failure (ARF) - "Gagal Ginjal Akut" (GGA)

This document provides definitions, pathophysiology, classification, signs, symptoms, and management of acute renal failure (ARF). ARF is defined as the clinical condition where the kidney's ability to maintain homeostasis is impaired, commonly presenting with oliguria. It can be pre-renal (functional), renal (organic/parenchymal injury), or post-renal (obstructive). Management involves fluid resuscitation, preventing further kidney damage and complications, maintaining electrolyte and acid-base balance, treating infections, and potentially dialysis. Outcome depends on the cause, severity, and adequacy of treatment.

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Yockie Verinico Simamora
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29 views22 pages

Acute Renal Failure (ARF) - "Gagal Ginjal Akut" (GGA)

This document provides definitions, pathophysiology, classification, signs, symptoms, and management of acute renal failure (ARF). ARF is defined as the clinical condition where the kidney's ability to maintain homeostasis is impaired, commonly presenting with oliguria. It can be pre-renal (functional), renal (organic/parenchymal injury), or post-renal (obstructive). Management involves fluid resuscitation, preventing further kidney damage and complications, maintaining electrolyte and acid-base balance, treating infections, and potentially dialysis. Outcome depends on the cause, severity, and adequacy of treatment.

Uploaded by

Yockie Verinico Simamora
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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ACUTE RENAL FAILURE

(ARF)
-------------------------------------GAGAL GINJAL AKUT
(GGA)
1

DEFINISI:
KEADAAN KLINIS DIMANA FS GINJAL
(GLOM. FILTRATION RATE = GFR)
GGL MPERTAHANKAN HOMEOSTASIS:
- FLUIDS
- ELECTROLYTES
- HASIL AKHIR METABOLISME PROT
BIASA DISERTAI OLIGURIA = URINE
OUTPUT ( 240 ML/ M2/ DAY)
DISEBUT OLIGURIC RF
BISA NON-OLIGURIC RF
0.5% KENAIKAN KREATININ SERUM / HARI

PATOGENESIS ARF:
BILA PERFUSI DARAH KE GINJAL
(MIS: OK HIPOTENSI / DEHIDRASI) MAKA
FILTRASI GINJAL PRODUKSI
URINE OLIGURIA (BILA 240
ML/M2/DAY + GGN KESEIMBANGAN AIR,
ELEKTROLIT DAN SISA METAB. PROT =
ARF)
A. RENALIS

V. RENALIS

ANATOMY OF KIDNEY

PEMBAGIAN PENYEBAB ARF


1. FUNCTIONAL ( PRE-RENAL):
A. DEHIDRASI
B. NEPHROTIC SYNDROME
C. CONGESTIVE HEART FAILURE
D. HIPOTENSI:
- NEONATAL ASPHYXIA
- HEMORRHAGE
- SEPTIC SHOCK
5

2. ORGANIC (RENAL PARENCHYMAL INJURY)


A. AGN
B. HUS
C. PURPURA FULMINANS
D. HYPERURICEMIA
E. ACUTE TUBULAR/ CORT. NECROSIS
F. ART./ VENA RENALIS THROMBOSIS
G. CONGENITAL MALFORMATION
H. MYOGLOBINURIA/ HEMOGLOBINURIA
I. NEPHROTOXIC DRUGS
6

3. OBSTRUCTIVE (POST RENAL)


A. UROLITHIASIS
B. HYDRONEPHROSIS
C. RENAL DYSPLASIA
D. KERACUNAN JENGKOL

BEDA ANTARA FUNCTIONAL DAN ORGANIC


ARF:
-------------------------------------------------------------------YANG DIUKUR
FUNC.
ORG.
-------------------------------------------------------------------KONSENT. URINE
HIGH
ISOTONIC
URINE OSM. (mOSM) > 320
< 310
URINE SOD. (mEQ/L) < 30
> 30
Na/K IN URINE
<1
>1
U/P UREA NITROGEN > 20
< 10
U/P KREATININ
> 20
< 15
-------------------------------------------------------------------8

PATOFISIOLOGI ARF:
WS PH PUB
----------------------------------------------------------------------------PRIMARY EVENT
EFEK
KONSEKUENSI
-----------------------------------------------------------------------------------------WATER RETENSION HIPONATREMI
EDEMA OTAK
KEJANG
SOD.RETENTION
EKSPANSI ECFHIPERTENSI
EDEMA PARU
POT. RETENTION
HIPERKALEMI
ARITMIA, CARD.
ARREST
H+ RETENTION
ASIDOSIS

HIPERKALEMI
PHOS. RETENTION
UREA & UREMIC

HIPOKALSEMI

TETANI, KEJANG
BLEEDING,

MANAJEMEN ARF:

A. FASE OLIGURIA
B. DIURETIK
C. PENYEMBUHAN

A. FASE OLIGURIA
1. TERAPI AWAL:
REHIDRASI (FLUID CHALLENGE)
- IVFD LAR. GARAM ISOTONIK / RL
20 - 30 ML/KG SELAMA 1 JAM
- MONITOR VITAL SIGN
(HEMODYNAMIC MONITORING !)
[NADI, NAPAS, TENSI, PROD. URINE]
BILATENSI; PROD U. > 12 ML/M2/MNT
OLIGURIC RF OK HYPOPERFUSION)

10

BL PRODUKSI URINE TIDAK 12 ML/M2/MNT,


ADA 2 KEMUNGKINAN:
1. MASIH DEHIDRASI, ATAU
2. SUDAH TERJADI RF
SEKALI RF TERJADI, HARUS DIUSAHAKAN
PCEGAHAN RF LEBIH LANJUT DENGAN:
- FUROSEMIDE, ATAU
- MANNITOL, ATAU
- DOPAMIN
MCEGAH KERUSAKAN LEBIH LANJUT,
MPERBAIKI PERFUSI GINJAL
D.P.L: YG RUSAK TETAP RUSAK, YG LAIN
DICEGAH JANGAN SAMPAI RUSAK

11

DOSIS: [SILAKAN LIHAT BUKU AJAR !]


- FUROSEMIDE:
1 - 2 MG/KG/IV/12 JAM, DSS TINGGI : 6 MG /KG
- MANNITOL:
0.5 MG/ KG/ IV, 20% SELAMA 2 JAM
- DIURESIS, TDK PD SEMUA
- TDK DIURESIS: FUNGSI & PROGNOSIS
- DOPAMIN :
NEONATE 0.5-2 G/KG/MNT
CHILD 1-5 G/KG/MNT
EFEK MUNCUL SSDH 1-2 JAM
KELEBIHAN DOSIS:
12
NAUSEA, VOMITING,TACHYCARDIA,

2. TERAPI LANJUTAN:
2.1. MCEGAH KELEBIHAN CAIRAN
2.2. PBERIAN KALORI / NUTRISI CUKUP
2.3. MPBAIKI K'SEIMBANGAN ELEKTR.
2.4. MPBAIKI KSEIMBANGAN AS-BASA
2.5. MPBAIKI TENSI
2.6. MOBATI KEJANG
2.7. MOBATI INFEKSI
2.8. DIALYSIS
13

2.1. MCEGAH KELEBIHAN CAIRAN:


CAIRAN PERHARI
25 ML / 100 KAL + URINE O.P, BISA DI HITUNG VIA HOLLIDAY SEGAR
MIS: ANAK 10 KG PERLU 1000 KAL
BUTUH AIR 250 ML / HARI
INSENSIBLE W.L (400-500 ML/M2/DAY)
+ URINE O.P
ANAK 10 KG = 0.5 M2
BUTUH AIR: 0.5 X 500 ML = 250 ML/DAY
BL CAIRAN TDK LEBIH, BESOK BB TDK
MASIH DITOLERIR BL BB 1-2% / DAY 14

2.2. PBERIAN KALORI / NUTRISI CUKUP:


KEBUTUHAN KALORI MINIAL PADA ARF:
400 KAL / M2 / DAY ATAU 20 - 25% DARI
KEBUTUHAN ANAK NORMAL (RDA)
MISAL:
ANAK 10 KG 1000 KAL
20% = 200 KAL
BSA = 0.5 M2
0.5 X 400 = 200 KAL
15

2.3. MPBAIKI KESEIMBANGAN ELEKTROLIT


A) KELEBIHAN KALIUM / HIPERKALEMIA
- CALCIUM GLUCONAS 10%
0.5 mEQ / KG / IV
TOXIC EFFECT KALIUM PD COR
- HYPERTONIC SOD. BIC. 7.5%, 3 mEQ/KG:

pH DARAH K+ MASUK KE SEL


K+ DALAM DARAH
- GLUCOSE & INSULIN:
50% GLUCOSE 1 ML / KG
INSULIN 1 U / ML
MPCEPAT SINTESA GLIKOGEN
UPTAKE K+ K+ DARAH 16

- CATION EXCHANGED RESIN


(SOD. POLYSTERENE SULFONATE =
KAYEXALATE)
DOSIS: 1 G RESIN DPT 1 mEQ K+
(1 G DILARUTKAN DLM 3-4 ML 5% DX)
VIA NGT ATAU RECTAL TUBE
BISA 1 - 4 X PER HARI
- LAR. ASAM AMINO
* YG MENGANDUNG HISTIDIN
* MSTABILISER & ME BUN
* ME KADAR KALIUM
* ME KADAR PHOSPHATE
* DOSIS: 0.5-3 G / KG / HARI
17
DISERTAI ELIMINASI K DLM DIETNYA

B) HIPONATREMI
- KADAR NATR. OK ECF
- HIPONATREMI RINGAN: LAMBAT
- HIPONATREMI BERAT: SEGERA
(< 120 mEQ/L)
- PAKAI RUMUS UMUM:
(Cd - Ca) X fd X BB (KG)
= mEQ YANG PERLU
fd NATRIUM = 0.7
2.4.MPBAIKI KESEIMBANGAN ASAM-BASA
- METAB. ACIDOSIS: PHITUNGKAN DARI
BERAPA BASE DEFICIT
- PAKAI RUMUS UMUM: fd BIC.NAT = 0.5-0.618

2.5. MEMPERBAIKI TENSI


1. MILD HYPERT. : < 10 MMHG DI ATAS 95%TILE
GARAM + HCT/ FUROSEMIDE P.O
2. MODERATE HYPERT.: 10-20 MMHG > 95%TILE
GARAM + RESERPIN / PROPANOLOL /
HYDRALAZINE P.O
3. SEVERE HYPER: > 20 MMHG DIATAS 95%TILE
4. CRISIS HYPERTENSION
SYSTOLE 180 MMHG:
DC
ENCEPHALOPATHY
DIASTOLE > 120 MMHG:
PAPIL EDEMA
TERAPI 3&4: GARAM + CLONIDIN INJ
ATAU NIFEDIPINE P.O + FUROSEMIDE IV 19

2.6. MENGOBATI KEJANG: DIAZEPAM / FENOBARB.


2.7. MENGOBATI INFEKSI: ADA OBAT YG PERLU
DIMODIFIKASI PEMBERIANNYA ADA YG TIDAK
2.8. DIALYSIS
* INDIKASI YG DIANJURKAN:
- FLUID OVERLOAD REFRACT. TO MEDICINE
MANAGEMENT ASS. WITH HYPERT. CHF
- HYPERKALEMIA REFRACT. TO MEDICINE
- ACIDOSIS REFRACT. TO MEDICINE
- SEVERE HYPONATREMIA
- SYMPTOMATIC UREMIA
- RAPIDLY BUN, CREATININE
- SUPPORTIVE DIALYSIS (PARENT.NUTRITION)20

B. FASE DIURETIC
- URINE O.P MULAI PROGRESIF
- CAIRAN DAN DIET TIDAK DIBATASI
(HATI-HATI BISA DEHIDRASI)

C. FASE PENYEMBUHAN
- FUNGSI KEMBALI N, TGANTUNG:
* PENYEBAB RF
* SEVERITY
* CEPAT PENGOBATAN
* ADEKUAT PENGOBATAN
- MORTALITY 20%
PENYEBAB TBANYAK:
SEPSIS, RESP. FAILURE, CARD. FAILURE &
BRAIN DAMAGED

21

TERIMA KASIH

22

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