a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
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Slides of 1 of my colleague... Hazwan

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  • Izinkan sy berkongsi kisah benar mengenai arabic gum kpd Tuan/Puan.

    kisahnya macam ni.
    setahun yang lalu pakcik sy mengalami sakit buah pinggang peringkat akhir dan menjalani rawatan dialisis di Hospital Pulau Pinang. makcik sy datang dari Sudan datang menziarahi pakcik dan membawa 'Arabic Gum' untuk pakcik.
    selepas kurang 10 hulan mengamalkan makanan dari syurga ini, Alhamdulillah pakcik sembuh dari penyakit buah pinggang dan dialisis dihentikan.
    Dengan nada gembira pakcik hubungi makcik pada jun 2013 untuk ucap terima kasih dan meminta benih pohon akasia yang mengeluarkan 'Arabic Gum' itu untuk ditanam di rumah tapi sayangnya pohon akasia hanya boleh tumbuh di tempat asalnya saja iaitu sudan.

    Setelah membuat kajian kasihatan dan pasaran, sy dan makcik bersetuju untuk membawa Arabic Gum ke Malaysia dalam kuantiti yang banyak untuk tujuan beramal dan berniaga kerana cara pemakanannya amat mudah, amat murah dan paling penting ia berkesan (Dengan izin Allah).

    Tuan/Puan boleh dapatkan maklumat lanjut dgn menaipkan Arabic Gum / Getah Arab / Al Manna / Acacia Powder di Internet.
    Di negara arab ia digelar 'Bread from heaven' kerana Arabic Gum atau Al manna ini ada disebut di dalam kitab Al-Quran dalam surah Al-baqarah ayat 57.
    Info:-
    Getah Arab ini hanya terdapat di Sudan. Tidak hairanlah kenapa negara Sudan menjadi rebutan sesetengah pihak.

    Getah Arab (Gum Arabic) sejenis prebiotik asli yang hanya terdapat di Sudan mempunyai potensi dalam industri perubatan, makanan dan solek antarabangsa akan dapat menguatkan kedudukan Malaysia sebagai sebuah hab halal dengan adanya penyelidikan rapi mengenainya yang dipelopori UKM.

    Ramli, 41 tahun, adalah juga bukti khasiat getah ini kerana beliau dahulu terpaksa menjalani rawatan dilasis tiga kali seminggu kerana buah pinggangnya sudah tidak berfungsi. Berkat penggunaan getah itu selama tujuh bulan buah pinggangnya sudah puleh dan beliau sejak 10 bulan kebelakangan ini tidak lagi perlu menjalani rawatan itu.

    Prebiotik adalah sejenis makanan untuk bakteria semula jadi yang terdapat dalam perut yang menentukan pengkhadaman makanan dapat berfungsi dengan baik. Bahan ini kini terdapat dalam makanan seperti berteh, beberapa jenis roti dan juga kapsul kebanyakannya di impot dari Barat.

    Kelebihan getah Arab dari Sudan ini ialah lebih 90 peratus daripadanya adalah jenis terbaik dan diperolehi secara semula jadi dari dua jenis pohon acasia yang hanya boleh di tanam di Sudan. Usaha menanamnya di negara jiran Sudan seperti Chad dan juga di Amerika telah gagal.

    Penyelidikan Terhadap Khasiat Getah Arab di UKM
    Rabu, 29 Jun 2011
    http://www.ukm.my/news/index.php/ms/berita-kampus/758-ukms-research-into-gum-arabic-set-to-create-international-demand-for-it-.html




    Sungguh niat sy hanya ingin membantu sesama saudara islam sy atau sesisapa sahaja.
    kami menjualnya dengan harga yang amat murah RM45(untuk pos) RM40 (C.O.D = cash on delivery), boleh tahan untuk sebulan.(boleh bandingkan dgn kos rawatan dialisis sebulan).

    ruangan ini amat terbatas untuk beri penerangan dengan jelas tentang apa itu arabic gum, so jangan segan untuk hubungi sy atau sms sy pun boleh untuk dapatkan informasi lebih lanjut. insya Allah sy akan beri gambaran jelas tentang Arabic Gum ini.

    Tuan/Puan boleh hubungi sy di:
    samsurijal 0128634538
    andreaboy786@gmail.com

    sekian wassalam
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a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan Presentation Transcript

  • A Comprehensive Approach toKidney Disease and Hypertension PAWANG HAZWAN Unit Ginjal dan Hipertensi Ilmu Penyakit Dalam
  • GinjalFungsi Ginjal• Regulasi volume cairan• Regulasi keseimbangan elektrolit• Regulasi keseimbangan asam dan basa• Regulasi tekanan darah (RAAS)• Regulasi eritropoesis• Ekskresi sampah metabolik• Metabolisme vitamin D• Sintesis prostaglandin
  • Apa penyebab Gagal Ginjal ?
  • AkutGagal Ginjal Kronik
  • • Chronic – CKD: Chronic Kidney Disease• Acute – ARF: Acute Renal Failure – AKI: Acute Kidney Injury• Acute Classification – Pre-renal – Renal – Post-renal
  • The CKD problem• Clinically silent in the early stages• Cost of renal disease can be extreme to health care service• Effects of renal disease can be extreme on patient• Treatments now available to slow progression• Need an “early warning” system for CKD
  • Diseases of the Kidney• Diabetes• Hypertension• Atherosclerosis• Glomerular diseases All global renal diseases• Toxins – Gentamicin affect glomerular – NSAIDS filtration rate (GFR) – Compound analgesics• Inherited diseases• Tubular disorders
  • Definition of CKD• Kidney damage for 3 months – Defined by structural or functional abnormalities of the kidney, with or without decreased glomerular filtration rate (GFR)• Reduced GFR for 3 months• New staging for chronic kidney disease (CKD) is primarily based on kidney function.National Kidney Foundation (NKF). Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.
  • • Glomerular Filtration Rate is the volume of fluid passing through the glomerulus in a given period of time.• Influenced by renal perfusion pressure, renal vascular resistance, glomerular damage, post-glomerular resistance.• “Normal Range” approx 90 - 150 mL/min – Approx 170 L per day• A larger healthy person has a higher GFR – Can be reported as 90 - 150 mL/min/1.73m2• Values fall with increasing age
  • Other reasons for estimating the GFR• Monitoring progression of CKD• GFR estimates are used for drug dosing decisions – Dosing of renally excreted drugs – Avoiding nephrotoxic drugs• Risk factor for cardiovascular disease mortality• Renal involvement in systemic diseases, such as diabetes mellitus or SLE
  • Sign n SymptomsUraemia symptoms;Bad breath (urinous,ammonia)Oedema (eyes, face, arms,hands, feet)HypertensionExtended neck veinsFatigue (anaemia,toxic substances)Neurological disturbances (lethargy, confusion,sleep disorders) J Winterbottom 2005
  • Sign n SymptomsNausea & vomitingHeadachesPruritus (phosphate, calcium, aluminium)BreathlessnessBone & joint problems (calcium/phosphate imbalances,VitD deficiency,demineralization)Bone pain J Winterbottom 2005
  • InvestigationHbUrea n electrolyteCreatinineAlk phosphatasePTHUrineimaging J Winterbottom 2005
  • Bagaimana dengan Anemia Renal ?
  • Anemia Rates Increase as Levels of CKD Severity Progress 100 Hgb Values Anemia Prevalence (%) 10 80 15 11-12 g/dL 60 15 10-11 g/dL <10 g/dL 8 40 17 62 9 8 43 20 5 20 14 0 <2 2-2.9 3-3.9 ≥4 Creatinine (mg/dL) Chronic Kidney Disease (CKD) ProgressionHgb = hemoglobin.Kausz et al. Dis Manage Health Outcomes. 2002;10:505-513.
  • Normal Gagal Ginjal
  • Chronic kidney disease (CKD) Anemia is an expected complication of CKD Treatment Increased cardiovascular morbidityrecombinant human erythropoietin(r-HuEPO) Left Ventricular Hypertrophy (LVH) Congestive Heart Failure (CHF)
  • Diambil : Jerome Rossert dkk, Nephrol Dial Transplant (2002) 17: 359–362
  • Why are CKD/ESRD Patients Predisposed to CV Disease? CKD/ESRDANEMIA INFLAMMATION plus CaP deposition LVH/CHF LIPIDS HTN CAD and PVD CV DISEASE AND DEATH
  • Why are CKD/ESRD Patients Predisposed to CV Disease?• 30-50% of ESRD patients have INFLAMMATION (increased CRP, increased IL-6, decreased albumin) – Increased CRP is a primary marker for inflammation predicting cardiovascular disease in normal adults – Increased CRP is the primary marker for increased cardiovascular mortality on dialysis• CKD/ESRD patients have metastatic calcification (coronary arteries) because of secondary hyperparathyroidism and elevated PO4 levels.
  • Bagaimana hubungan antara hipertensi dengan CKD ?
  • Distribution of hypertensives (65-89 years) MEN WOMEN ISOLATEDISOLATED SYSTOLICSYSTOLIC 59.3% 63.6% 30.3% 27.7% 10.4% 8.7% COMBINED COMBINED ISOLATED ISOLATED DIASTOLIC DIASTOLIC Framingham study
  • Factors Affecting Blood Pressure Blood Cardiac TotalPressure = Output X Peripheral Resistance Amount of blood ejected per minute Blood flow through blood vessels
  • Prevalence of HTN in CKD 80% of patients with glomerulonephritis and 30% of patients with chronic interstitial disease are hypertensive.
  • Aggressive BP Control, Proteinuria andCKD Progression – what is the optimal BP for CKD? 0 <1 gm/D 1-2.9 >3 gm/D -2 gm/D -4 Mean fall <125/75 in GFR -6 (ml/min/yr) * <140/90 -8 * -10 Klahr S et al, N Engl J -12 Med 330:877, 1994 GOAL BP<125/75 if >1 gm proteinuria
  • Angiotensin II plays a central role in organ damage Atherosclerosis* Stroke Vasoconstriction Vascular hypertrophy Endothelial dysfunction HypertensionA II LV hypertrophy Fibrosis Remodeling Heart Failure Death Apoptosis MI GFR Proteinuria Renal Failure Aldosterone release Glomerular sclerosis *Preclinical data. LV = left ventricular; MI = myocardial infarction; GFR = glomerular filtration rate.
  • Renin Angiotensin Aldosterone System Non-ACE pathways Vasoconstriction (eg, chymase) Cell growth Na/H2O retention Sympathetic activationAngiotensinogen Renin Angiotensin I AT1 Angiotensin II ACE Aldosterone AT2 Cough, Vasodilation Inactive Antiproliferationangioedema Bradykinin fragments (kinins) Benefits?
  • Decreased Increasedvasodilatory angiotensin IIprostaglandins Low GFR
  • How About Renal Osteodystrophy
  • Bone Disease in CKD Metabolic abnormalities  Hyperphosphatemia  Hypocalcemia  PTH elevation
  • Bone Disease in CKD Renal Osteodystrophy  Osteomalacia / osteitis fibrosis cystica / osteosclerosis  Metastatic calcification  Vascular!
  • Bone Disease in CKD Renal Osteodystrophy
  • Matur nuwun