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Pendahuluan
 ADQI (Acute Dialysis Quality Initiative)
2002
 ARF (Acute renal failure)  AKI (acute kidney
injury)
 Istilah ini mencakup semua tahapan gangguan
ginjal akut dari yang paing ringan sampai ke
tahapan gagal ginjal
 AKIN (Acute Kidney Injury Network) 2004
 Roesli 2008  menggunakan terjemahan
Gangguan Ginjal Akut untuk mengganti
istilah Gagal Ginjal Akut

Roesli. Gangguan Ginjal Akut. 2008

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Epidemiologi

www.ADQI.net

Angka kematian

Critical Care 2008, 12:144

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Epidemiologi

 Roesli dkk 2007 melaporkan

 Dalam kurun waktu Maret 2005 dan Oktober
2006 terdapat 987 pasien di ICU, 60 orang
diantaranya (6,1%) mengalami AKI.
Semuanya sudah dalam kategori RIFLE F

Roesli. Gangguan Ginjal Akut. 2008

Definisi
 Secara tradisional  penurunan fungsi
ginjal secara mendadak alam beberapa
jam sampai beberapa minggu
 Definisi lain sangat banyak dan
beragam
 ADQI melengkapi dengan suatu kriteri
yang disebut RIFLE
 AKIN 2005 modifikasi kriteria RIFLE

Roesli. Gangguan Ginjal Akut. 2008

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Kriteria Diagnosis
 An abrupt (within 48 hours) reduction in
kidney function currently defined as an
absolute increase in serum creatinine of
more than or equal to 0.3mg/dl (≥ 26.4
μmol/l), a percentage increase in serum
creatinine of more than or equal to 50%
(1.5-fold from baseline), or a reduction
in urine output (documented oliguria of
less than 0.5 ml/kg per hour for more
than six hours).

Mehta. www.akinet.org

www.ADQI.net

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AKIN stage for AKI

Mehta. www.akinet.org

Patofisiologi

Comprehensive Clin Nephrol 2010

J Am Osteopath Assoc. 2009;109:13-19.

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Etiologi
 Pre renal • Renal • Post renal
 Kehilangan – Tubuler – Obstruksi
Volume Nekrosis
cairan tubuh ureter
akut
 Penurunan – Obstruksi
– Nefritis
volume efektif
interstitialis kandung
vaskuler kemih dan
akut
 Redistribusi uretra
cairan – GNA
 Obstruksi – Oklusi
renovaskuler glomerular

Pre-Renal Renal

Post-Renal

Comprehensive Clin Nephrol 2010

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Comprehensive Clin Nephrol 2010

Agen nefrotoksik

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Agen Nefrotoksik

Comprehensive Clin Nephrol 2010

Tahapan AKI
 Risk dan Injury
 Failure
 Poliuri
 Recovery

Roesli. Gangguan Ginjal Akut. 2008

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Progresifisitas AKI

Clin J Am Soc Nephrol 2008;3: 881-886

Manifestasi Klinis
 A history of vomiting, diarrhea, hemorrhage, sepsis and/or
decreased oral intake resulting in hypovolemia, associated
with decreased urine output suggests AKI due to prerenal
disease or ATN.

 Physical examination findings that include tachycardia, dry

mucous membranes, orthostatic blood pressure changes,
and decreased skin turgor suggest hypovolemia, resulting in
AKI due to prerenal disease or ATN.

 A history of pharyngitis or impetigo, a few weeks prior to the

onset of gross hematuria suggests post-infectious
glomerulonephritis.
Uptodate 18.2

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Manifestasi Klinik
 Nephrotic syndrome, heart failure, and liver failure may result
in edema and other signs of specific organ dysfunction.

 Hemoptysis in the presence of renal impairment suggests a

diagnosis of pulmonary-renal syndrome, which includes
Goodpasture's syndrome or Wegener's granulomatosis.

 Purpura, malar rash, or petechiae, and/or joint pain favor a
diagnosis of systemic vasculitis, such as systemic lupus
erythematosus or Henoch Schönlein purpura.

 In the hospital, ATN resulting from hypotension (due to sepsis

or intraoperative events) or from the administration of
nephrotoxic medications (such as aminoglycosides or
amphotericin-B) is the common cause of AKI.
Uptodate 18.2

Pemeriksaan Penunjang
 Pemeriksaan laboratorium
 Biokimiawi darah (ureum, creatinin)
 Pemeriksaan urin (sedimen, osmolalitas urin,
Fraksi eksresi natrium (FENa)

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Comprehensive Clin Nephrol 2010

Pemeriksaan radiologis
 Ultrasonografi
 Untuk melihat ukuran, parenkim, penilaian
batas kortek dan medula
 Adanya hydronefrosis

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Pemeriksaan Penunjang
Pre renal Renal Post-renal
Rasio >20:1 20:1
BUN/kreatinin
FENA < 1% >1%
Berat jenis urin >1.020 1.010-1.020
Osmolalitas urin 500 mOsm 250-300mOsm
Natrium urin <20 mmol/hari >40 mmol/hari
Sedimen urin Granuler cast Hyalin cast
USG normal Normal Red cell cast
Hydronefrosis
pielonefrosis

J Am Osteopath Assoc. 2009;109:13-19.

Roesli. Gangguan Ginjal Akut. 2008

Petunjuk Biomarker
 Penanda proses inflamasi
 Cystatin C
 Interleukin -18 (IL 18)
 neutrophil gelatinase-associated lipocalin
(NGAL),
 Penanda kerusakan tubuli
 kidney injury molecule-1 (KIM-1)

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Comprehensive Clin Nephrol 2010

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Tatalaksana
 Successful management of AKI requires :
 early recognition of the diagnosis,
 investigation of the causes of AKI,
 Management of complications,
 timely RRT,
 prevention of ongoing kidney injury,
 aggressive supportive care,
 and correction of the primary disorders. D
 Despite many advances in the therapy of
AKI, mortality rates remain constant at
about 50–80%.

International Journal of Nephrology and Renovascular Disease 2010:3 129–140

Tatalaksana pre-renal
 Penggantian cairan  isotonik NaCl dan
transfusi darah pada perdarahan
 Cardiac failure  inotropik, anti aritmia
 Sirosis hepatis  hepatorenal syndrome
 Large volume paracentesis + albumin
 Koreksi komplikasi (asam basa,
gangguan elektrolit)
 Pemantauan  monitoring secara
invasif (CVP)

Harrison’s. Principles of Medicine. 17th ed

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Tatalaksana aki renal

 Ischemic ATN
 stabilisasi hemodinamik dan menjaga renal
perfusi
 Nefrotoksik ATN
 Menghindari agen nefrotoksik
 Forced diuresis
 Alkalinisasi pada SLT
 GN atau vasculitis  immunosupressive
agent

Harrison’s. Principles of Medicine. 17th ed

Tatalaksana AKI post-renal

 Kolaborasi dengan urologis dan
radiologis
 Obstruksi uretra  kateter suprapubik
 Obstruksi ureter  percutaneus
catheterization of the dilated renal
pelvis

Harrison’s. Principles of Medicine. 17th ed

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Indikasi terapi pengganti ginjal

 Dialysis is often used to support renal
function until renal repair/recovery occur.
 Absolute indications for dialysis include
symptoms or signs of the uremic
syndrome and management of
refractory hypervolemia, hyperkalemia,
or acidosis.
 Modalities of dialysis
 Intermittent dialysis, SLED, CRRT

Harrison’s. Principles of Medicine. 17th ed

Indikasi terapi pengganti ginjal

Clin J Am Soc Nephrol 2008; 3: 876-880

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Prognosis
 The in-hospital mortality rate among
patients with ARF ranges from 20 to
50% or more, depending on underlying
conditions.
 Most patients who survive an episode of
ARF recover sufficient renal function to
remain dialysis-independent,
 10–20% go on to require maintenance
dialysis.

Harrison’s. Principles of Medicine. 17th ed

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