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Hemodialisis pada ketoasidosis diabetik dengan Acute Kidney Injury Stage Failure: Case Series dari Bali, Indonesia

Abstract

Introduction: Acute kidney failure is defined as sudden loss of kidney function, resulting in decreased glomerular filtration rate (GFR). The causes of acute kidney failure can be divided into pre-renal, renal, and/or post-renal and can be secondary to other conditions, such as diabetic ketoacidosis (DKA). Acute kidney failure in DKA can be managed conservatively, but in some cases, kidney replacement therapy is required. This case series discusses the effectiveness of renal replacement therapy in children with acute kidney failure.

Case series: This series deals with two cases of adolescents who were taken to the emergency unit with DKA. The kidney function test showed a decrease in GFR of more than 75%, indicating the absence of acute kidney failure failed stage as a complication of severe DKA. Both patients with severe DKA did not respond well to initial hydration, so severe acidosis worsened and blood sugar levels increased significantly, so hemodialysis was needed. Because the patients were hemodynamically unstable, sustained low-efficiency dialysis (SLED) was performed. One patient showed clinical improvement after early hemodialysis, and the other showed clinical improvement after several hemodialysis sessions.

Conclusion: Patients with acute kidney injury stage failure who did not show any improvement after hydration should consider renal replacement therapy.

 

Pendahuluan: Gagal ginjal akut (GGA) didefinisikan sebagai hilangnya fungsi ginjal secara tiba-tiba, yang mengakibatkan penurunan laju filtrasi glomerulus (LFG). Penyebab GGA dapat dibagi menjadi pre-renal, renal, dan/atau post-renal, dan dapat terjadi sekunder akibat kondisi lain, seperti ketoasidosis diabetik (KAD). Ketoasidosis diabetik itu sendiri disebabkan oleh pre-renal. Gagal ginjal akut pada KAD dapat dikelola secara konservatif, tetapi dalam beberapa kasus terapi penggantian ginjal diperlukan. Seri kasus ini membahas efikasi terapi penggantian ginjal pada anak-anak dengan KAD yang mengalami acute kidney injury stage failure.

Seri Kasus: Seri kasus ini membahas dua kasus remaja laki-laki yang dibawa ke unit gawat darurat dengan KAD berat. Uji fungsi ginjal menunjukkan penurunan LFG lebih dari 75%, menunjukkan adanya acute kidney injury stage failure sebagai komplikasi dari KAD berat. Kedua pasien dengan KAD berat tidak menunjukkan respons yang baik terhadap hidrasi awal, sehingga asidosis berat memburuk daripada sebelumnya dan kadar gula darah meningkat secara signifikan sehingga hemodialis diperlukan. Karena pasien tidak stabil secara hemodinamik, dilakukan sustained low-efficiency dialysis (SLED). Salah satu pasien menunjukkan perbaikan klinis setelah hemodialis awal, dan yang lainnya menunjukkan perbaikan klinis setelah beberapa sesi hemodialis.

Kesimpulan: Pasien dengan acute kidney injury stage failure yang tidak menunjukkan perbaikan setelah hidrasi, sebaiknya mempertimbangkan terapi penggantian ginjal.

References

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How to Cite

Yasa, K. D., Nilawati, G. A. P. ., Mahakrishna, B. N. ., & Setiyawan, I. M. K. . (2024). Hemodialisis pada ketoasidosis diabetik dengan Acute Kidney Injury Stage Failure: Case Series dari Bali, Indonesia. Medicina, 55(1), 5–10. https://doi.org/10.15562/medicina.v55i1.1251

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Karuna Dhorayho Yasa
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Gusti Ayu Putu Nilawati
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Bagus Ngurah Mahakrishna
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I Made Karma Setiyawan
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