Definition of Chronic Kidney Failure

CHRONIC RENAL FAILURE

Definition of Chronic Kidney Failure

Chronic renal failure is a clinical syndrome caused kidney function decline is a chronic, progressive and irreversible lasts. This happens when the Glomerular Filtration Rate (LFG) of less than 50 ml per minute. Chronic renal failure can be reduced in accordance with the stages, mild, moderate or severe. End stage kidney failure (end-stage renal failure) were stage renal failure which can lead to death unless replacement therapy (Suhardjono, 2003).

Chronic kidney disease is kidney damage that occurs for more than 3 months, based on patalogis abnormalities or markers of kidney damage such as proteinuria. If there are no signs of kidney damage, chronic kidney disease diagnosis is made if the value of the glomerular filtration rate of less than 60ml per minute per 1.73 m2 (National Kidney Foundation Kidney Disease Outcomes Quality Initiative quoted Arora, 2009). Disease with chronic renal failure (CRF) is one of the non-communicable diseases, renal dysfunction is a condition that is chronic and progressive ongoing irreversible (can not back kekeadaan original). Where the body fails to maintain the capability and keseimbangancairan and electrolyte metabolism, leading to uremia (retention of urea and other nitrogen waste in the blood).

Classification of Chronic Kidney Failure

Classification of chronic renal failure can be seen by a clinical syndrome caused by decreased function is reduced, mild, moderate and late stage (Suhardjono, 2003). There are several classifications of chronic renal failure, published by the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K / DOQI). Classification include the following:

a. The first stage (stage 1)

It is a stage where there has been an increase in kidney damage with LFG (> 90 mL/min/1.73 m2) or normal LFG

b. The second stage (stage 2)

Reduction LFG began to decrease slightly (mild category) is 60-89 mL/min/1.73 m2

c. The second stage (stage 3)

Reduction of LFG has more reduced (moderate category) is 30-59 mL/min/1.73.

d. The second stage (stage 4)

LFG reduction is very much reduced 15-29 mL/min/1.73.

e. The second stage (stage 5)

Renal failure has occurred with LFG is <15 min="" ml="" span="">(Arora, 2009)

Etiology of Chronic Renal Failure

Causes of chronic kidney disease can be divided into 3 parts, namely diabetic disease, non-diabetic renal disease and kidney transplant disease. In the diabetic kidney may be caused by diabetes type 1 and 2. cause of the non-diabetic kidney disease is glomerular disease (an autoimmune disease, systemic infection, neoplasia), vascular disease (disease of the large blood vessels, hypertension and microangiopathic) tubulointerstisial diseases (urinary tract infections, stone obstruction and drug toxicity) and cystic disease (kidney disease Polycystic).
In transplants of kidney disease can be caused by chronic rejection, drug toxicity, recurrent disease and transplant glomerulopati (Suhardjono, 2003 quoted from Susalit). Krause (2009) adds that the cause of chronic renal failure is very diverse. Knowledge of the underlying cause of the disease is important to know because it will provide the basis for selection of the treatment given. The cause was kidney failure among others include:

a.       The cause with the highest frequency in the adult as well as children are glomerulonephritis and interstitial nephritis.

b.      Chronic infections of the urinary tract (the cause of all ages).

c.       Chronic renal failure can also be experienced ana-child with congenital abnormalities such as chronic hydronephrosis resulting dam on the flow of urine or the urine flows from the bladder back.

d.      Congenital abnormalities of the kidney.

e.       Hereditary nephropathy.

f.       Diabetic nephropathy and hypertension is generally a cause in adulthood.

g.      Polycystic disease, blood vessel disorders of kidney and analgesic nephropathy causes quite often.

h.      In some areas, HIV-related kidney disorders cause more frequent.

i.        Certain diseases such as glomerulonephritis in patients with renal transplantation. Dialysis is the right choice in this condition.

j.        Circumstances relating to the individual who received immunosuppressive drugs for mild to moderate kidney transplant. Or immunosuppressive drugs during the transition period after kidney transplantation are given to prevent the body's rejection of transplanted kidneys cause the patient at risk for developing infections, including viral infections such as herpes zoster.

Travel Clinic

General travel progressive renal failure can be divided into three stages, namely the first stage, second stage and third stage or late (Price & Wilson, 1995).

a. First Stage

The first stage is called the decline in renal reserve. During this stage the serum creatinine and urea nitrogen levels normal area and asymptomatic patients. Impaired kidney function can be in the know with the urinary concentration test of time or with a glomerular filtration rigorous tests.

b. Second Stage

The second stage is called renal insufficiency, in which more than 75% of tissue function has been damaged. At this stage the serum creatinine levels also started to increase beyond normal levels, symptoms of nocturia and polyuria developed.

c. Third Stage or End Stage

This stage is called end-stage renal failure or uremia, occur when approximately 90% of the mass of nephrons have been destroyed or only about 200,000 are still intact nephron. Serum creatinine and blood urea nitrogen levels will go up very strikingly in response to decreased glomerular filtration.

Disease Prevention Chronic renal failure

Primordial prevention in patients with chronic renal failure meant providing state of the general public that allows a predisposing factor for chronic renal failure can be prevented and not have the support base of the habits, lifestyle, and other risk factors. For example, by creating the preconditions so as people find that drinking 8 glasses a day to maintain healthy kidneys are important, regular exercise, consumption of fatty foods and excessive salt is not good habits that ultimately the community is expected to be positive towards healthy consumption.

Primary Prevention

Complications of chronic kidney disease can be prevented with early treatment. Therefore, efforts should be implemented are effective prevention of chronic kidney disease, and this is possible due to a variety of risk factors for chronic kidney disease can be controlled. Primary prevention against chronic kidney disease can be:

a. Inhibition of hypertension to lower blood pressure to normal

b. to prevent the risk of kidney function decline

c. Control of blood sugar, blood lipids and anemia

d. Cessation of smoking

e. Weight control.

f. Drink plenty of water so that the urine is not concentrated and able to accommodate /

g. dissolve all of the salt to prevent stone formation.

h. Of salt, the higher konsuumsi salt, the higher

i. calcium excretion in the urine, which may facilitate the formation of crystallization.

j. Reduce foods that contain high protein and high cholesterol.

Secondary Prevention

Secondary prevention in the form of conservative management consists of treatment of comorbid illnesses (comorbidities) to inhibit the progression, maintaining a better prognostic value and lower secondary prevention mortalitas.1 management can be divided into 2 groups:

a. Conservative Treatment

Conservative treatment aims to capitalize on the remaining kidney function, eliminating various weighting factor, and slow the progression of kidney failure as early as possible. Conservative Treatment of Chronic renal disease (CRF) consisting of:

b. Early Detection and Treatment of Primary Disease

Identification (early detection) and soon improve (treatment) primary disease or factors that can worsen renal physiology is critical to slow the progression of kidney failure a terminal kidney failure.

c. Setting dietary protein, potassium, sodium, and fluid

(I). Protein Proper protein diet will slow the urea poisoning. Protein restriction begins at the start of kidney disease with a protein intake of 0.5 to 0.6 g / kg bw / day, with a high biological value. Restriction of protein in the diet of patients with chronic renal failure can reduce the symptoms of anorexia, nausea, and vomiting, and, if given early can inhibit the progression of the disease.

The main actions to prevent the occurrence of hyperkalemia is to limit intake of potassium in the diet. Potassium is often increased due to decreased excretion of potassium through the urine. Hyperkalemia can cause cardiac distress and sudden death. So avoid the consumption of foods or drugs that high levels of potassium University of North Sumatra as an expectorant, potassium citrate, soup, dates, bananas, and squash.

Sodium

Setting sodium diet is important in patients with renal failure. The recommended amount of sodium is 40 to 90 mEq / day (1 to 2 g of sodium). The maximum sodium intake should be determined individually for each patient so good hydration can be maintained.
Sodium intake is too loose can cause fluid retention, peripheral edema, pulmonary edema, hypertension and congestive heart failure.

Fluid

Taken fluid intake of patients with chronic renal failure should be monitored carefully. Fluid intake too free circulation lead to excessive weight, edema and intoksitasi water. While the intake of too little cause dehydration, hypotension and renal dysfunction.