Gangguan Renal Akut

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Acute Renal Failure (ARF) ditandai dengan penurunan secara mendadak kadar filtrasi glomerular (GRF) dan alternasi kemampuan ginjal untuk mengeluarkan racun harian (Bagan 39-2). Kejadian ARF dapat berhubungan dengan penurunan produksi urin (oliguria, dengan produksi kurang dari 500 ml dalam waktu 24 jam), ataupun dengan aliran urin yang normal. Gangguan ini biasanya menyerang ginjal yang sebelumnya sehat/tidak terkena gangguan apapun. Durasinya berbeda-beda dari beberapa hari hingga beberapa pekan. Penyebab ARF sangat bermacam-macam, dan sering ada beberapa yang terjadi secara bergantian (Boks 39-1). Secara garis besar, penyebab terjadinya ARF dapat dikelompokkan menjadi tiga, yaitu: (1) kurangnya perfusi renal (prerenal), (2) penyakit yang terjadi pada parenkima renal (intrinsic), dan (3) obstruksi (postrenal). Biasanya, jika dilakukan pemeriksaan dengan diagnosis yang cermat saat terjadi prerenal dan obstruksi, ARF tidak akan berumur panjang dan tidak memerlukan intervensi nutrisi khusus.

ARF intrinsik dapat disebabkan oleh asupan obat-obatan yang mengandung racun, alergi sebagai reaksi terhadap obat-obatan, glomerunefritis yang sangat progresif, atau terlalu lamanya episode iskemia yang menyebabkan nekrosis tubular akut iskemik. Dari kesemua penyebab ini, pasien merasakan kesakitan karena adanya komplikasi infeksi yang berlebihan, trauma berat, kecelakaan saat dioperasi, atau shock karediogenik.
Penanganan klinis berikut hasilnya sangat bergantung pada penyebabnya. Pasien penderita ARF yang disebabkan oleh konsumsi obat yang mengandung racun biasanya akan benar-benar pulih sehat setelah berhenti mengkonsumsi obat dimaksud. Sementara itu, angka kematian pasien penderita nekrosis tubular akut iskemik yang disebabkan oleh shock mencapai sekitar 70%. Pada umumnya, pasien tersebut sangat katabolik, serta menderita kerusakan jaringan ekstensif pada tahap-tahap awal timbulnya penyakit. Untuk mengurangi terjadinya nekrosis, diperlukan hemodialisis. Hemodialisis ini berguna untuk mengurangi asidosis, memperbaiki uremia, dan mengontrol hiperkalemia.

Jika gejala pemulihan telah ditemukan, maka pemulihan ini akan memakan waktu 2-3 pekan. Tahap pemulihan (diuretik) pertama-tama ditandai oleh kenaikan output urin dan selanjutnya oleh kembalinya eliminasi racun dalam tubuh. Selama periode ini, dialisis masih diperlukan dan perhatian yang cermat harus diberikan terhadap keseimbangan cairan dan elektrolit.

Sumber: Bahan Kuliah Mahasiswa Fakultas Kedokteran Universitas Diponegoro Semarang

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