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Defnisi Acute Kidney Injury
(AKI) Dan penerapanyaPada Praktek Klinis
Mark E. Thomas1, Caroline Blaine2, Anne Dawnay3, Mark A. J.
Devonald4
, Saossen !"oh2
, Chris #ain$%
, Ssan #a"&hem2
, Andrew#ewin$"on', David (. Mil)ord* and Marlies +s"ermann
1De-ar"men" o) enal Medi&ine, Birmin$ham /ear"lands /os-i"al,Birmin$ham, 0 2a"ional Clini&al ideline Cen"re, #ondon, 0
3De-ar"men" o) Clini&al Bio&hemis"ry, 0niversi"y Colle$e #ondon
/os-i"als, #ondon, 0 4o""in$ham enal and Trans-lan" 0ni",o""in$ham 0niversi"y /os-i"als, o""in$ham, 0 %0niversi"y Colle$e#ondon Cen"re )or e-hrolo$y, oyal !ree /os-i"al, #ondon, 0
'De-ar"men" o) e-hrolo$y, #eeds Tea&hin$ /os-i"als, #eeds, 0*De-ar"men" o) e-hrolo$y, Birmin$ham Children5s /os-i"al,Birmin$ham, 0 and De-ar"men"s o) e-hrolo$y and Cri"i&al Care,
y5s 6 S" Thomas5 /os-i"al, #ondon, 0
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• A&"e idney 7n8ry 9A7: adalah sindrom
mm yan$ se&ara inde-enden dikai"kanden$an -enin$ka"an mor"ali"as.
• De;nisi A7 "elah
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• >enin$ka"an ke&il -ada krea"ininserm se&ara inde-enden dikai"kanden$an -enin$ka"an mor"ali"as, dan
den$an i" dimaskkan ke dalamde;nisi ars A7.
• De;nisi "erkini dari -edoman D7+
in"ernasional adalah $a
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• Tin8aan ini akan mem
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ena-a di-erlkan de;nisi "en"an$A&"e kidney in8ry@
• A7 adalah sindrome yan$ serin$ dankadan$, men$han&rkan den$an
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• De;nisi yan$ ideal hars memiliki
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>erkem
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• Aki dide;nisikan se
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• ideline International Kidney DiseaseImproving Global Outcomes 9D7+s:
men$a
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Ta
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>er
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Pengukuran dari ungsi ginjalpada dewasa dengan AKI
• >ada onse" A7, asmsi dari kersakan"n$$al sim-el -ada $in8al, se-er"i -ene"a-an-eriode iskemia, ! yan$ se
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• ms -ersamaan Modifcation o Dietin Renal Disease 9MDD: dikem
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liguria se!agaiindikator AKI
• +li$ria rine o"-" N 4==mlhari
• +li$ria serin$ "er8adi -ada-erawa"an in"ensi), namn 8aran$diik"i den$an A7
• +li$ria "an-a -enin$ka"an krea"inin
menn8kkan mor"ali"as yan$ le
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"aktor#aktor yang mempengaru$i kreatinin serumpada pasien diduga AKI
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• 7n"er-re"asi ke"a" dari de;nisi oli$riaadalah -en$elaran rin N=,% mlk$8am-ada masin$masin$ ' 8am se&ara
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%etode lain dalam mengukurungsi ginjal pada AKI
• Belm ada me"ode lain yan$ "ersedian"k meman"a la8 ;l"rasi $lomerlsse&ara "ers meners n"k men$kr
)n$si $in8al -ada A7.• a
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• oleksi rin selama 2 sam-ai 4 8amden$an sam-el darah n"kmenen"kan krea"inin klirens adalah
me"ode yan$
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&aria!ilitas pengukuran kreatinindan rele'ansi ter$adap AKI
• !ak"or)ak"or yan$ mem-en$arhivaria
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atas !awa$ ungsi ginjal
• ilai
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• Se&ara las, me"ode "erse
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• D7+ menyarankan -en$$naan krea"inin"erendah selama -erawa"an se
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•
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Defnisi AKI pada penggunaanpraktik se$ari#$ari
• Sis"em in)orma"ika -ada keseha"an "elahdikem
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• >em
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Si"asi khss
• Ak" -ada CD
• A7 semen"ara
•
on"ras -emi& A7• A7 saa" di 7C0
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Ak" -ada CD
• A
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A7 semen"ara
• A7 semen"ara san$a" &e-a"
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• >asien yan$ "elah
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on"ras -emi& A7
• >erkem
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• De"eksi dari A7 karena kon"ras
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A7 saa" di 7C0
• A7 serin$ "er8adi -ada -asien yan$men8alani -erawa"an di 7C0. De;nisiA7
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• ala-n -ada -rak"ik klinisnyasan$a"
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A7 >edia"rik
• >en$kran )n$si $in8al -ada anakanak den$an A7. Se"elah sia da"ahn, -erkem
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A7 an$$an in8al Ak"
Cr krea"ininee! -erkiraan la8 ;l"rasi$lomerls ! la8 ;l"rasi $lomerls#en$"h -an8an$
/ei$h" "in$$i
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A7 an$$an in8al Ak"Cr krea"ininee! -erkiraan la8 ;l"rasi$lomerls ! la8 ;l"rasi $lomerls
#en$"h -an8an$/ei h" "in i
!+M0#A#AMA
!+M0#A BA0
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• >en$naan 8i isotope-dilution massspectrometry-calibrated enzymaticcreatinine n"k sema -asien -edia"ri&
seen$naan e! yan$ dies"imasi oleh
S&hwar" se"elah revisi n"k mende"eksiA7 -ada anakanak perlu studi le!i$lanjut
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Defnisi p*I"+, AKI pada anak#anak
• Modi;kasi -edia"rik n"k kri"eria7!#E 9-7!#E: dikemandan D7+ mer8k kri"eria
-7!#E n"k de;nisi A7 -ada anakanak, dan kemdian men8adi yan$di$nakan n"k anakanak
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• ri"eria -7!#E kemdiandikon;rmasi memiliki nilai. ri"eria inimem
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• a-i"elli dkk menemkan
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• Bila "idak ada hasil krea"inin yan$"ersedia dalam 8an$ka wak""erse
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• S&hneider dkk men$nakan klasi;kasi7!#E
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• Terda-a"
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• S"di men$enai automatedelectronic intervention a"ain"ervensi elek"ronik "era"oma"isasi
n"k men$ran$i -a-aran "erhada-ne-hro"oin, dikom
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• >en$halan$ "erda-a" dalam a-likasi r"in dari
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• Disarankan
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• Se
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• Biomarker
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• >eneli"ian yan$ -an8an$ hars dimlaievalasi nya sekaran$ oleh -elaksana
-rak"isi -ada klinikal yan$ "elah memiliki