Upload
yuhumaqyu6841
View
223
Download
0
Embed Size (px)
Citation preview
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 1/19
Renal replacement therapy
dr. Drajat
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 2/19
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 3/19
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 4/19
Years Until Kidney Failure (GFR < 15 mL/min/1.73 m2)
Based on Level of GFR and Rate of GFR Decline
Level of GFR
(mL/min/1.73 m2)
Rate of GFR Decline (mL/min/1.73 m2 per year)
10 8 6 4 2 1*
90 7.5 9.4 13 19 38 75
80 6.5 8.1 11 16 33 65
70 5.5 6.8 9.2 14 28 55
60 4.5 5.6 7.5 11 23 45
50 3.5 4.4 5.8 8.8 16 35
40 2.5 3.1 4.2 6.3 13 25
30 1.5 1.9 2.5 3.8 7.5 15
20 0.5 0.6 0.8 1.3 2.5 5
• Average age-related GFR decline after age 20-30 year
•MDRD Study: average rate of decline in GFR is 4 ml/min/year. 85% declined,15% stabile or improvement
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 5/19
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 6/19
Attemps to prevent and correct acute decline
on chronic renal failure
• Volume depletion
• IV radiographic contrast
•Antimicrobial agent (aminoglycoside,amphotericine B)
• NSAID (including Cox2)
• ACE/ARB
• Cyclosporine and tacrolimus• Obstruction of the urinary tract
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 7/19
Interventions that have been proven to be effective
Diabetic Kidney
Disease
Non diabetic
Kidney disease
Kidney disease
In the transplant
Strict giycemic
control
Yes * I:80-120
II:100-140
HbA1C(%):<7
NA Not tested
ACE – inhibitors or
angletensin-receptor blockers
Yes Yes
(greater affect in patients withproteinuria)
Not tested
Strict blood pressure
control
Yes
< 125/75 mm
Hg
Yes
<130/80 mm Hg
(greater affect in patients with
proteinuria)
<125/75 mm Hg(greater affect in patients with
proteinuria)
Not tested
* Prevents or delays the onset of diabetic kidney discase.
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 8/19
Should be referred to nephrologist
• Most cases of nonprogressive chronic kidney disease can bemanaged without referral to a nephrologist.
• Referral to a nephrologist is recommended :
- patients with acute kidney failure
- GFR less than 30 mL/min/1.73 m2
- progressive decline of kidney function
- inability to achieve treatment targets
- urine albumin to creatinine ratio greater than 500
mg/24 h)
Guidelines for the management of chronic
kidney disease (Canadian Medical Association)
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 9/19
Late vs early referral
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 10/19
• Pernefri,2005 : KK < 15 ml/min for DM, <10 ml/min for non DM. Earlier if uremicsymptoms persist.
• National Kidney Foundation (2006) estimated GFR ≤ 15.0 ml per minute
and ≥ 15.0 ml per minute when patients have coexisting conditions or
symptoms of uremia
• Canadian Society of Nephrology, 2008 → Patients with an estimated GFR <20 mL/min/m2 may require initiation of renal replacement therapy if any of
clinical indicator are present:
- symptoms of uremia (after excluding other causes)
- refractory metabolic complications (hyperkalemia, acidosis)
- volume overload (manifesting as resistant edema or hypertension)
- decline in nutritional status (as measured by serum albumin, lean
body mass or Subjective Global Assessment) that is refractory to
dietary intervention .
Timing of initiation renal replacement therapy
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 11/19
Level of GFR at initiation of replacement
therapy in US
USRDS,1999
Data 2009 :
- eGFr of ≥15 ml/min/1.73 m2
increased from 4% to 17%
- eGFr of ≥15 ml/min/1.73 m2
increased from 4% to 17%
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 12/19
Modality renal replacement therapy
(for chronic kidney disease)
• Kidney transplant
• Hemodialysis (HD)
•Continuos Ambulatory Peritoneal Dialysis(CAPD)
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 13/19
kidney transplant
Data resipien donor
ABO/Rh o/+ o/+HLA A24(A9),A66/A10(?) A(11)?
Crossmatch ±20%, pasca imuran 2 mg : 20%HBsAg/Anti -/+ -/-
HSV1 IgG+/IgM+ IgG+/IgM-HSV2 IgG+/IgM+ IgG-/IgG-Anti CMV IgG+/IgM- IgG+/IgM-HCV -tive -tiveHIV -tive -tiveVDRL/TPHA -tive/-tive -teve/-tiveHb 9,1 12,3Lekosit 5.7 5.4Trombosit 186 300
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 14/19
Hemodialysis
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 15/19
6
7
8
1
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 16/19
Preparation
of access for
HD
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 17/19
CAPD
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 18/19
Preparation for CAPD
7/28/2019 Renal replacement therapy (kuliah S1 perawat).pptx
http://slidepdf.com/reader/full/renal-replacement-therapy-kuliah-s1-perawatpptx 19/19
Apa peranan perawat pada
penanganan pasien CKD ?
• Asuhan keperawatan pasien CKD
• Asuhan keperawatan pasien renalreplacement therapy (kidney
transplant,HD,CAPD)• Perawat OK (operasi kidney
transplant,CAPD,akses HD)
• Perawat dialisis : melaksanakan HD, merawatkateter HD dan CAPD
• Edukasi pasien