Penyakit Ginjal Kronis dengan Anemia, Hiperkalemia, dan Hipoalbuminemia pada Pasien Wanita 41 Tahun: A Case Report

Abdillah A.F Hasanusi; Susan Timisela

doi:10.55606/termometer.v3i4.5539

Authors

Abdillah A.F Hasanusi Universitas Pattimura
Susan Timisela Universitas Pattimura

DOI:

https://doi.org/10.55606/termometer.v3i4.5539

Keywords:

Anemia, Chronic Kidney Disease, Hyperkalemia, Hypoalbuminemia, Renal Replacement Therapy

Abstract

Chronic Kidney Disease (CKD) is a global health issue with an increasing prevalence each year. One of the most significant complications of CKD is anemia, which occurs due to decreased erythropoietin production as a result of kidney damage. Erythropoietin plays a vital role in stimulating red blood cell production, and its deficiency leads to decreased hemoglobin and hematocrit, worsening quality of life, increasing cardiovascular risk, and accelerating kidney disease progression. This case report presents a 41-year-old female with complaints of bilateral lower leg edema for one week, accompanied by weakness and repeated vomiting. The patient has a history of poorly controlled kidney failure. Physical examination revealed pale conjunctiva and leg edema, while vital signs showed hypertension (BP 160/80 mmHg). Laboratory results revealed severe anemia (Hb 3.3 g/dL, HCT 9.2%, erythrocytes 1,007,000/mm³), severe renal dysfunction (urea 401 mg/dL, creatinine 18 mg/dL), hypoalbuminemia (2.7 g/dL), hyperkalemia (K 5.3 mmol/L), and a decreased glomerular filtration rate (6.29 mL/min/1.73m²), indicating CKD stage 5. This clinical manifestation emphasizes the strong relationship between CKD and anemia due to erythropoietin deficiency, exacerbated by metabolic disturbances and fluid retention. Management includes anemia correction through blood transfusion, erythropoietin supplementation, electrolyte disturbance management, and renal replacement therapy such as hemodialysis. Early detection and routine CKD management are critical to prevent severe anemia and life-threatening systemic complications. This case report aims to serve as a reference for clinical practice in managing CKD and its complications.

Downloads

Download data is not yet available.

References

Cockwell, P., & Fisher, L. A. (2020). The global burden of chronic kidney disease. The Lancet, 395(10225), 662–664. https://doi.org/10.1016/S0140-6736(19)32977-0

Don, B. R., & Kaysen, G. (2004). Poor nutritional status and inflammation: Serum albumin—Relationship to inflammation and nutrition. Seminars in Dialysis, 17(6), 432–437. https://doi.org/10.1111/j.0894-0959.2004.17603.x

Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: Pathophysiology, risk factors, and consequences. Nephrology Dialysis Transplantation, 34(Suppl_3), iii2–iii11. https://doi.org/10.1093/ndt/gfz206

Kalantar-Zadeh, K., Jafar, T. H., Nitsch, D., Neuen, B. L., & Perkovic, V. (2021). Chronic kidney disease. The Lancet, 398(10302), 786–802. https://doi.org/10.1016/S0140-6736(21)00519-5

Kalengkongan, D. J., Makahaghi, Y. B., & Tinungki, Y. L. (2018). Faktor-faktor risiko yang berhubungan dengan chronic kidney disease (CKD) pada penderita yang dirawat di Rumah Sakit Daerah Liunkendage Tahuna. Jurnal Ilmiah Sesebanua, 2(2), 100–114.

Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements, 12(1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003

Ladesvita, F. (2021). Hubungan laju filtrasi glomerulus dengan kadar hemoglobin dan kalsium pada pasien gagal ginjal kronik yang menjalani hemodialisis. Indonesian Journal of Health Development, 3(2), 272–284. https://doi.org/10.52021/ijhd.v3i2.101

Lv, J. C., & Zhang, L. X. (2019). Prevalence and disease burden of chronic kidney disease. In Renal fibrosis: Mechanisms and therapies (pp. 3–15). Springer. https://doi.org/10.1007/978-981-13-8871-2_1

Palmer, B. F., & Clegg, D. J. (2017). Diagnosis and treatment of hyperkalemia. Cleveland Clinic Journal of Medicine, 84(12), 934–942. https://doi.org/10.3949/ccjm.84a.17056

Ratna, M. E., Windartik, E., & Pratiwi, R. M. (2023). Hubungan kadar hemoglobin (Hb) dengan kelelahan (fatigue) pada pasien gagal ginjal kronis yang menjalani hemodialisa di ruang HD RSI Siti Hajar Sidoarjo [Skripsi, Universitas Bina Sehat PPNI].

Romagnani, P., Remuzzi, G., Glassock, R., Levin, A., Jager, K. J., Tonelli, M., & Anders, H. J. (2017). Chronic kidney disease. Nature Reviews Disease Primers, 3(1), 1–24. https://doi.org/10.1038/nrdp.2017.88

Sanjaya, A. A. G. B., Santhi, D. G. D. D., & Lestari, A. A. W. (2019). Gambaran anemia pada pasien penyakit ginjal kronik di RSUP Sanglah pada tahun 2016. Jurnal Medika Udayana, 8(6), 1–6.

Teo, G. (2021). Diagnosis dan tatalaksana kegawatdaruratan hiperkalemia. Cermin Dunia Kedokteran, 48(8), 305–310. https://doi.org/10.55175/cdk.v48i8.112

Ukratalo, A. M., & Sangdji, J. M. (2023). Efek ekstrak methanol kulit batang Cinnamomum burmannii terhadap penurunan kadar kreatinin sebagai indikator perbaikan ginjal mencit (Mus musculus) model diabetes mellitus. Jurnal Ilmu Kesehatan dan Sains Nusantara (JIKSN), 1(1), 34–43.

Utami, E. P. (2021). Hubungan level eosinofil terhadap skor Geriatric Nutritional Risk Index (GNRI) dan luaran klinis pasien penyakit ginjal kronis (PGK) yang menjalani hemodialisis reguler [Skripsi, Universitas Hasanuddin].

Viera, A. J., & Wouk, N. (2015). Potassium disorders: Hypokalemia and hyperkalemia. American Family Physician, 92(6), 487–495.

Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The Lancet, 389(10075), 1238–1252. https://doi.org/10.1016/S0140-6736(16)32064-5

Yuniarti, W. (2021). Anemia in chronic kidney disease patients. Journal Health & Science: Gorontalo Journal Health and Science Community, 5(2), 341–347. https://doi.org/10.35971/gojhes.v5i2.11632

Zha, Y., & Qian, Q. (2017). Protein nutrition and malnutrition in CKD and ESRD. Nutrients, 9(3), 208. https://doi.org/10.3390/nu9030208