kidney failure on dental care gagal ginjal.ppt
TRANSCRIPT
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Laksmi Maharani, M.Sc., Apt.
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Fungsi Homeostasis GinjalMengatur :1.Jumlah cair tubuh2.Osmolaritas cairan 3.Konsentrasi ion-ion penting dalam cair
tubuh4.Keseimbangan asam - basa
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Minum kopiVasodilatasi vas afferent
GFR >>
Produksi urine >>
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Perubahan tekanan hidrostatik dalam capsula BowmanObstruksi saluran seni ( batu ginjal /ureter )Edema jaringan ginjal Obstruksi tekanan
hidrostatik capsula Bowman >> Filtrasi <<
GFR <<
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Perubahan tekanan colloid osmotic plasmaDehidrasi tekanan colloid osmotic plasma
>> filtrasi glomerulus <<
Hipoproteinemia tekanan colloid Osmotic plasma << GFR >>
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Perubahan permeabilitas membran GlomeruliPenyakit ginjal kapiler glomeruli sangat permeabel protein plasma dapat menembus kapiler proteinuria hipoproteinemia GFR >>
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Perubahan luas area filtrasiPenyakit yang merusak glomeruli
Nephrectomy partial
Luas area filtrasi << GFR <<
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Pengendali sekresi AldosteronACTH
Na+ ekstra sel : rendah Ald. >> tinggi Ald. <<
K+ ekstra sel : tinggi Ald. >> rendah Ald. <<
Angiotensin II
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Renal ischemia menyebabkan:Juxta Glomerular Apparatus meningkatkan
produksi Renin
Angiotensinogen
Angiotensin I Angiotensin Converting
Enzyme
Angiotensin II
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Plasma ClearanceMerupakan jumlah ml plasma yang
dibersihkan seluruhnya dari suatu zat dalam satu menit
Dibersihkan --- > diekskresi melalui urine
Clearance Inulin = 125 ml/menit 125 ml plasma telah dibersihkan seluruhnya dari Inulin / menit Inulin dekskresikan lewat urine
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Pengaruh ADH pada sekresi ureumADH >> : - permeabilitas duct coll.terhadap air >> air
keluar dari duct coll . ke peritubuler- Duct. Coll pada medulla ginjal permeabilitasnya thd ureum >> air +
ureum keluar dari duct.coll ke peritubuler pengeluiaran urine & eksresi ureum <<
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Antara GFR-Cr Serum-dan Gagal Ginjal
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Tatalaksana Penyakit GinjalPengobatan
Pengobatan utama dengan diuretikTergantung gejala
Mual-muntah H2 bloker, PPI, anti-emetik Anemia suplemen zat besi Infeksi lanjut (ISK) antibiotik
Dialisis
Transplantasi
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Dental ConditionsGagal ginjal sendiri bisa menyebabkan
beberapa penyakit terkait kesehatan gigiKemampuan penyerapan kalsium yang
terganggu pada pasien Gagal ginjal menyebabkan pengeroposan tulang periodontal
Ketidak mampuan pengeluaran urea dari tubuh juga menyebabkan bau nafas akibat pembentukan amonia
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Pasien dengan DialisisPasien ini akan menerima heparin
(antikoagulan) sehingga harus menunggu seluruh obat tersebut dibersihkan dari tubuh untuk memberikan tindakan yang bisa mengakibatkan luka. Waktu tunggu sekitar 24 jam atau lebih.
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Pasien dengan Transplantasi GinjalPasien dengan transplantasi ginjal akan
menerima obat penekan sistem imun sehingga pemberian tatalaksana gigi akan beresiko infeksi fatal
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Obat-obatan untuk Pasien Gagal GinjalKarena kemampuan ginjal menyaring dan
mengekskresikan obat menurun, beberapa obat perlu disesuaikan dosisnya pada pasien gagal ginjal
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Cockroft-Gault Formula
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TERIMAKASIH