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Injuri Ginjal Akut Akibat Sepsis pada Pasien di ICU

Departemen Anestesiologi and Terapi Intensif, Fakultas Kedokteran, Universitas Padjadjaran, Bandung, Indonesia

Received: 9 Oct 2022; Published: 31 Mar 2023.

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Abstract

Acute kidney injury (AKI) merupakan suatu sindroma klinis akibat penurunan fungsi ginjal. AKI merupakan salah satu komplikasi yang paling sering terjadi pada pasien kritis. 50% pasien di intensive care unit (ICU) bisa mengalami terjadinya AKI dan 13,5% memerlukan terapi pengganti ginjal.

Pasien AKI mempunyai risiko kematian meningkat tiga kali lipat, risiko terjadinya chronic kidney dieseses tujuh kali lipat, dan risiko terjadinya end state renal diseases 22 kali lipat.

Kriteria diagnosis dari risk injury failure lost and end-stage kidney disease (RIFLE), acute kidney injury network (AKIN), dan kidney disease improving global (KDIGO) digunakan untuk mendiagnosis AKI di ICU. Ketiga kriteria ini menggunakan parameter serum kreatinin, dan urine output. Selain itu untuk mendiagnosis AKI di ICU juga digunakan beberapa pencitraan seperti ultrasonografi.

Pengelolaan AKI di ICU meliputi terapi nondialisis dan terapi pengganti ginjal. Terapi non dialisis adalah diuretik, mempertahankan keseimbangan cairan, asam basa, elektrolit dan nutrisi. Terapi pengganti ginjal meliputi beberapa modalitas seperti chronic renal replacement therapy, intermitten hemo dialysis, slow low extended dialysis, and peritoneal dialysis. Pada pasien di ICU, continous renal replacement therapy merupakan modalitas utama.

Pada pasien kritis di ICU dengan AKI mempunyai prognosis yang buruk sehingga merupakan masalah besar. Pemahaman yang lebih baik dalam diagnosis dan pengelolaan secara dini dan tepat merupakan pendekatan utama untuk memperbaiki luaran pasien.

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Keywords: AKI; diagnosis; intensive care unit; prognosis; sepsis

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