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1.

Estimasi GFR
- The MDRD Equation
GFR (mL/min/1.73 m2) = 175 (Scr)-1.154 (Age)-0.203 (0.742 if female) (1.212 if African
American)
- This CKD-EPI equation
GFR = 141 min (Scr /, 1) max(Scr /, 1)-1.209 0.993Age 1.018 [if female] 1.159 [if
black]
where:
Scr is serum creatinine in mg/dL,
is 0.7 for females and 0.9 for males,
is -0.329 for females and -0.411 for males,
min indicates the minimum of Scr / or 1, and
max indicates the maximum of Scr / or 1.

2. Stage CKD
Albumin 4+ menandakan adanya kidney damage
GFR 30 (GFR 30-69 Moderate decrease of GFR)
Sehingga jika abnormalitas lebih dari 3 bulan termasuk Stage 3 CKD

3. Etiologi karena adanya risk factor seperti diabetes dan hipertensi yang tidak dikontrol
dengan baik menyebabkan injury berulang pada struktur ginjal sehingga menyebabkan
chronic kidney disease
4. Strategy to deal CKD
Setelah diagnosis CKD ditegakkan, dilakuan staging berdasarkan kidney damage dan
penurunan GFR untuk menentukan evalusi dan manajemen selanjutnya

Pada kasus karena sudah terjadi penurunan GFR makan dilakukan evaluasi komplikasi
pencegah dan terapi komplikasi dan persiapan replacemen.

5. Strategy to control blood pressure


- intervensi lifestyle dengan DASH (dietery approaches to stop hypertention)
- intervensi farmakologi

Target dan Anti hipertensi yang bisa dipilih

Side effect should be anticipated


Slowing CKD progression using ACEi or ARB has to be considered: risk/benefit of these
drugs and should be carefully assessed in the elderly and medically fragile. Check labs
after initiation of treatment; if less than 25% SCr increase, continue and monitor and if
more than 25% SCr increase, stop ACEi and evaluate for RAS acting drugs. Avoid
volume depletion and avoid ACEi and ARB in combination. Monitor risk of adverse
events (impaired kidney function, hyperkalemia)

6. Strategy to control blood glucose


- Lifestyle measures, including diet and exercise in DKD, avoid salt intake, obesity, and
sedentary living
- Terapi farmakologi to establish and maintain tight blood glucose control,

Target : with a target HbA1c of 7%, namun bisa lebih tinggi tergantung dengan
adanya korbiditas, terbatas life expentacy dan resiko hypoglikemia

For patients who are relatively young (50 years) and have no other significant
comorbid conditions, we suggest using an A1C goal of 7 to 7.5, rather than higher
values (Grade 2C).

For older patients (ie, >50 years) who have multiple comorbid conditions, we suggest
using an A1C goal of 7.5 to 8, rather than lower values (Grade 2C

Antidiabetes yang bisa dipilih


For nondialysis CKD patients with type 2 diabetes, we suggest initial treatment with an
oral agent, rather than insulin (Grade 2B). The preferred agents and initial dosing
are glipizide (2.5 mg/day) orglimepiride (1 mg/day); an alternative agent is repaglinide,
starting with a dose of 0.5 mg/day. Metformin should not be used among CKD patients
with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, because of an
increased risk of lactic acidosis. Patients who fail therapy with oral agents are treated
with insulin. Among patients who are treated with insulin, the starting dose of insulin may
need to be lower than would ordinarily be used for patients with normal kidney function.
For most hemodialysis patients with type 2 diabetes, we suggest initial treatment with
insulin, rather than oral agents (Grade 2C). Several different insulin regimens can be
used to achieve glycemic control. Examples include: twice-daily intermediate-acting
insulin, with regular insulin given before breakfast and before supper, or long-acting
insulin, with two or three times daily supplemental regular insulin, given two or three
times per day before meals. The initial dose of insulin should be decreased by
approximately 50 percent. Some clinicians prefer to use oral agents rather than insulin,
especially among patients who have already achieved acceptable glycemic control on
these agents. If an oral agent is used, the preferred agents are glipizide or repaglinide.

Side effect should be anticipated : lactic acidosis, hypoglycemia

7. Other comorbidity should be anticipated and lab test should be done to confirm

- Anemia : check cbc

- CKD-mineral and bone disorder : check kadar calcium dan phosphate

- Metabolic acisosis : cek ph dan serum bikarbonat

- hiperkalemia : cek elektrolit


- dislipidemia yang merupakan resiko CVD : cek lipid profile (LDL, HDL, Tg, Total
cholesterol)