Post on 28-Feb-2018
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LAPORAN KASUS GH
AKI ON CKD
DEVI NOVITA
C 111 10 313
7/25/2019 LAPORAN KASUS GH.pptx
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IDENTITAS PASIEN
Nama : Salomina
RM : 05613
Um!" : 1# $ 10 $ 1%&% $ '6 ()n
*+ni, K+lamin : P+"+m-!an
Alama( : .alla Kal!a/ Mama,a
P++"aan : IRT
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Anamn+,i,
• K+l!)an !(ama : l+ma, 2an +n4a -a2a +2!a
(!n4aiS• Anamn+,i, (+"-im-in:
– Pa,i+n ma,! "!ma) ,ai( -a2a (an44al 1%$0'$'016 a"+na+l!)an l+ma, an4 2ialami ,+i(a" # )a"i ,++l!mna
L+ma, an4 2ialami +"lan4,!n4 (+"!, m+n+"!, 2an (i2a2i-+n4a"!)i a(i7i(a, D+mam 89/ m!al 89/ m!n(a) 89/a(! 89/ n+"i (+an -+"!( 8;/ n+"i !l! )a(i 89/-+"2a"a)an 89/ nam!n -a,i+n (am-a -!<a(
– Ri=aa( .A. : ia,a/ +"a 2a"a) 89/ +"a )i(am 89/ +,an
no"mal – Ri=aa( .AK : !nin4/ (i2a lan<a" 2an ,+2ii(/ a2an4 a2a
n+"i ,aa( +"+mi)
– Saa( ini/ -a,i+n (i2a m+n4+l!) l+ma, D+mam 89 89/ m!al
89/ m!n(a) 89/ a(! 89/ n+"i -+"!( a(a! n+"i !l! )a(i 89/-+"2a"a)an 89 .A. no"mal/ .AK n+"i ,aa( +"+mi)
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• Ri=aa( T+"2a)!l! – Ri=aa( HD (i2a a2a
– Ri=aa( !"+( ,+i(a" ' (a)!n an4 lal!8>+"!a"i '01#
– Ri=aa( )i-+"(+n,i (i2a a2a
– Ri=aa( DM (i2a a2a
– Ri=aa( ,ai( an(!n4 (i2a a2a
– Ri=aa( m+"oo 89• Ri=aa( K+l!a"4a
– Ri=aa( )i-+"(+n,i i! a-a 89
– Ri=aa( DM 89
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Ri=aa( So,ial
• Pa,i+n m+n4a! a2an4 min!m *am!2an oa( )+"al
• Ri=aa min!m min!man +",o2a
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• K+a2aan Um!m
• Sai( ,+2an4$Gi?i .ai$Com-o,m+n(i, – .. : # KG – T. : 1#% <m
– IMT: '1/1@
– 4$m'
• P+m+"i,aan i,i
– Tan2a Vi(al
• T+anan Da"a) : 110$0• Na2i : &#B$m+ni(
• P+"na-a,an : '0B$m+ni(
• S!)! 8ABilla : 36/5 C
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• K+-ala : No"mo<)+-al
•
Ma(a – An+mi, :A2a
– I(+"!, : Ti2a a2a
• L+)+" – P+m+,a"an K+l+na" 4+(a) +nin4 89
• T)o"a, – I : ,im+("i, i"i anan ,aa( in,-i"a,i 2an +,-i"a,i
– P : n+"i (+an (i2a a2a
– P : ,ono" i"i anan
– A : Ron)i 2an =)++?in4 (i2a a2a
• *an(!n4 – I : i<(!, <o"2i, (i2a nam-a
– P : i<(!, <o"2i, (+"aa
–
P : a(a,9 a(a, an(!n4 +,an no"mal – A : !ni an(!n4 I$II m!"ni "+4!l+"
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• A2om+n – I : Da(a"/ i!( 4+"aan na>a, – A : P+"i,(al(i !,!, +,an no"mal
– P : H+-a" 2an li+n (i2a (+"aa
– P : -+a
– MT : a2a
• E,("+mi(a, – E2+ma 8;
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HASIL PEMERIKSAAN LA. Tan44al 1$03$'016 8-o,( ("an,>!,i '!ni(
.C 16/0%R.C 3/1H. %/1HCT '&/'
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HASIL PEMERIKSAAN LA.
JENISPEMERIKSAA
N
HASIL NILAIRUJUKAN
Na 13' 136 1#5mmol$L
K 5/% 3/5 51mmol$L
Cl
U"+!m
"+a(inin
101
1'#
&/5
% 111mmol$L
0/53 m4$2l
0/691/3 m4$2l
• Nilai GR :
81#09!m!"B.. $ ' B"+a(inin-la,ma 81#09'6B #$' B &/5
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•
Diagnosis – AKI on CKD
Di2a,a"an a(a, +l!)an l+ma, an4 (i2a 2i-+n4a"!)i a(i7i(a,/-a,i+n m+milii -a,i+n (am-a -!<a(/ on!n4(i7a an+mi, 2an
-a2a !,4 2i 2a-a(an ma,,a +,a" -a2a "on44a -+l7i
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TIN*AUAN PUSTAKA
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AKI 8 ACUTE KIDNEF IN*URF
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KLASIIKASI .ERDASARKA KLASIIKASI RILE
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KLASIIKASI AKI .ERDASARKAN KDIGO'
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Etiologi
P+n+a 4a4al 4inal 2a-a( 2i+lom-oan+2alam:
• a(o" -"a"+nal/ ,+-+"(i )i-o7ol+mi/ )i-o(+n,i/2an )i-o,ia
• a(o" "+nal/ ,+-+"(i 4lom+"!lon+"i(i, a!(/oa4!la,i in("a7a,!la" (+"loali,a,i/ n+"o,i,(!!l!, a!(/ n+>"i(i, in(+",(i(ial a!(/ (!mo"/+lainan -+"+man4an/ 2an n+>"i(i, )+"+2i(+"
• a(o" -o,("+nal/ ,+-+"(i o,("!(i> ,al!"an+mi) aia( n+>"oli(ia,i,/ (!mo"/ +"a<!nan
+n4ol/ 2ll
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KLASIIKASI .ERDASARKAN
ETIOLOGI
.+"2a,a"an +(iolo4i/ 2ia4i 3:
• P"a"+nal
•
R+nal• Po,( "+nal
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PATOISOLOGI
2a"i a-,!la .o=man an4 m+n4i(a"i a-il+" 4lom+"ol!,/
(!!l!, on(o"(!, -"o,imal/ l+n4!n4 H+nl+/ 2an (!!l!, on(o"(!,
2i,(al an4 m+n4o,on4an 2i"i + 2!(!, -+n4!m-!l81
Dalam +a2aan no"mal ali"an 2a"a) 4inal 2an la! l("a,i 4lom+"ol!,
"+la(i> on,(an an4 2ia(!" ol+) ,!a(! m+ani,m+ an4 2i,+!(
o(o"+4!la,i D!a m+ani,m+ an4 +"-+"an 2alam a!(o"+4!la,i ini
a2ala) 8%:Uni( +"a >!n4,ional 4inal 2i,+!( ,+a4ai n+>"on S+(ia-n+>"on
(+"2i"i
• R+,+-(o" "+4an4an mio4+ni 2alam o(o( -olo, 7a,<!la" a"(+"iol
a>+"+n• Timal ali (!!lo4lom+"!la"
• S+lain i(! no"+-in+>"in/ an4io(+n,in II/ 2an )o"mon lain !4a 2a-a(m+m-+n4a"!)i a!(o"+4!la,i
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Pa2a 4a4al 4inal -"+9"+nal an4 !(ama 2i,+aan ol+)
)i-o-+">!,i 4inal Pa2a +a2aan )i-o7ol+mi aan (+"a2i
-+n!"!nan (+anan 2a"a)/ an4 aan m+n4a(i7a,i
a"o"+,+-(o" a"2io7a,!la" an4 ,+lan!(nam+n4a(i>a,i ,i,(im ,a"a> ,im-a(i,/ ,i,(im "+nnin9
an4io(+n,in ,+"(a m+"an4,an4 -+l+-a,an 7a,o-"+,,in2an
+n2o()+lin9I 8ET91/ an4 m+"!-aan m+ani,m+ (!!)!n(! m+m-+"(a)anan (+anan 2a"a) 2an <!"a)
an(!n4 ,+"(a -+">!,i ,+"+"al Pa2a +a2aan ini
m+ani,m+ o(o"+4!la,i 4inal aan m+m-+"(a)anan
ali"an 2a"a) 4inal 2an la! l("a,i 4lom+"!l!, 8LG2+n4an 7a,o2ila(a,i a"(+"iol a+"+n( an4 2i-+n4a"!)i
ol+) "++ mio4+ni/ -"o,(a4lan2in 2an nitric oxide
8NO/ ,+"(a 7a,oon,("i,i a"(+"iol a+"+n( an4 (+"!(ama
2i-+n4a"!)i ol+) an4io(+n,in9II 2an ET
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Gama"an Klini,• !mla) 7ol!m+ !"in+ +"!"an4 2alam +n(!
oli4o!"i ila -"o2!,i !"in+ J #0 ml$)a"i• an!"i ila -"o2!,i !"in 50 ml$)a"i/ !mla)
!"in+ J 1000 ml$)a"i (+(a-i +mam-!anon,+n("a,i (+"4an44! 2alam +a2aan ini
2i,+!( )i4) o!(-!( "+nal >ail!"+• !"+mia 2imana .UN 2i a(a, #0 mmol$l/
• +2+ma -a"! (+"a2i -a2a -+n2+"i(a an4
m+n2a-a( (+"a-i <ai"an
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PEMERIKSAAN PENUNJANG
• URINALISIS
• KIMIA DARAH• PEMERIKSAAN RADIOLOGI
• .IOPSI GIN*AL
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P+na(ala,anaan
• An(iio(i i,a 2i+"ian !n(! m+n<+4a) a(a!
m+n4oa(iin>+,i
• Un(! 4i?i an4 o-(imal -a2a GGA/ -+n2+"i(a
2ian!"an m+nalani 2i+( aa a"o)i2"a( ,+"(a"+n2a)
-"o(+in/na("i!m 2an ali!m
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Kom-lia,i
Kom-lia,i m+(aoli +"!-a +l+i)an
<ai"an/)i-+"al+mia/ a,i2o,i, m+(aoli/
)i-oal,+mia/ ,+"(a
-+nin4a(an !"+!m an4 l+i) <+-a( -a2a+a2aan
)i-+"a(aoli Pa2a oli4!"i 2a-a( (im!l
+2+maai/ )i-+"(+n,i 2an +2+ma -a"!/ an4
2a-a(
m+nim!lan +a2aan 4a=a(
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PROGNOSIS
AKI +"4an(!n4 +a2aan lini 2an
2+"aa( 4a4al 4inal P+"l! 2i-+")a(ian >a(o" !,ia/main
(!a main +l+ -"o4no,ana/ a2ana in>+,i an4
m+n+"(ai/ -+"2a"a)an 4a,("oin(+,(inal/ -+n+aan4
+"a( aan m+m-+"!"! -"o4no,a P+n+a+ma(ian
(+",+"in4 a2ala) in>+,i 830950/ -+"2a"a)an(+"!(ama
,al!"an <+"na 8109'0/ an(!n4 8109'0/ 4a4alna>a, 815/
2an 4a4al m!l(io"4an 2+n4an omina,i )i-o(+n,i/
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CKD 8 CRONIC KIDNEFDISEASES
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Epidemologi
• P"+7al+n,i -+nai( 4a4al 4inal "oni ,aa( ini (+"!, m+n4alami
-+nin4a(an 2i ,+l!"!) +la)an 2!nia Di-+"i"aan l+i) 2a"i 50 !(a-+n2!2! 2!nia m+n4alami PGK 2an 1 !(a 2a"i m+"+a m+m!(!)an(+"a-i -+n44an(i 4inal P+n+li(ian 2i +-an4 m+m-+"i"aan ,+i(a" 13 2a"i !mla) -+n2!2! a(a! ,+i(a" 13/3 !(a o"an4 an4 m+milii -+nai(4inal "oni -a2a (a)!n '005
• M+n!"!( 2a(a 2a"i CDC (a)!n '010/ l+i) 2a"i '0 !(a =a"4a Am+"ia S+"ia(an4 m+n2+"i(a -+nai( 4inal "oni/ an4a ini m+nin4a( ,+i(a" &,+(ia- (a)!na L+i) 2a"i 35 -a,i+n 2ia+(+, m+n2+"i(a -+nai( 4inal"oni/ 2an l+i) 2a"i '0 -a,i+n )i-+"(+n,i !4a m+mlii -+nai( 4inal"oni 2+n4an in,i2+n,i -+nai( 4inal "oni (+"(in44i 2i(+m!an -a2a !,ia65 (a)!n a(a! l+i)
• S(!2i 2i In2on+,ia m+n+!(an an4a in,i2+n,i -a,i+n PGK ,++,a" 30/-+"!(a -+n2!2! 2an an4a +a2iana ,++,a" '3/# -+"!(a -+n2!2! *!mla) -a,i+n an4 m+n2+"i(a -+nai( 4inal "oni 2i-+"i"aan aan (+"!,m+nin4a(/ -+nin4a(an ini ,+an2in4 2+n4an +"(ama)na !mla)
-o-!la,i/ -+nin4a(an -o-!la,i !,ia lan!(/ ,+"(a -+nin4a(an !mla) -a,i+n)i-+"(+n,i 2an 2ia+(+,
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• E(iolo4i – P+")im-!nan N+>"olo4i In2on+,ia 8PENERI m+n<a(a( -+n+a
4a4al 4inal 2i In2on+,ia :
1 Glom+"!lon+>"i(i, #6/3%' Dia+(+, M+li(!, 1&65
3 O,("!,i 2an in>+,i 1'&5
# Hi-+"(+n,i 
• a(o" R+,io – Am+"i<an Ki2n+ o!n2a(ion 8'01' m+n+!(an ++"a-a
>a<(o" "+,io 2a"i -+nai( 4inal a2ala) :
•. 1Dia+(+,
•. 'Hi-+"(+n,i$ (+anan 2a"a) (in44i
•. 3P+nai( an(!n4
•. #Ri=aa( +l!a"4a an4 m+milii -+nai( 4inal
•. 5.+"!,ia 2i a(a, 60 (a)!n
G Kli i
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Gama"an Klini,• S+,!ai 2+n4an -+nai( an4 m+n2a,a"i ,+-+"(i
– Dia+(+, M+li(!,
– In>+,i T"a(!" U"ina"i!,
– .a(! ("a(!, !"ina"i!,
– Hi-+"(+n,i
– Hi-+"!"i+mi
• Sin2"om !"+mia:
– L+ma)
– Ano"+,ia
– M!al m!n(a)
– No(!"ia
– Vol!m+ o7+"loa2
• G+ala om-lia,i: – Hi-+"(+n,i
– An+mia
– Paa) an(!n4
– A,i2o,i, m+(aoli
– Gan44!an +,+iman4an +l+("oli(
Gambaran Laboratorium
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Gambaran Laboratorium
• Ka2a" !"+!m/ "+a(inin ,+"!m
• LG
• H+mo4loin
• Hi-+" $ )i-oal+mia
• Gama"an Ra2iolo4i, – o(o Polo, a2om+n: .i,a Tam-a "a2io9o-a
– USG 4inal : m+m-+"li)a(an 4inal an4 m+n4+<il
P ( l
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P+na(ala,anaan
• P+na(ala,anaan -+nai( 4inal "oni m+li-!(i:
– T+"a-i ,-+,i (+")a2a- -+nai( 2a,a"na – P+n<+4a)an 2an (+"a-i (+")a2a- on2i,i omo"i2
– M+m-+"lama( -+m!"!an >!n4,i 4inal
– P+n<+4a)an 2an (+"a-i (+")a2a- om-lia,i
– T+"a-i -+n44an(i 4inal +"!-a 2iali,i, a(a! ("an,-lan(a,i 4inal
K li i
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Kom-lia,i
• Hi-+"al+mi
• Gan44!an +,+iman4an a,am a,a• Hi-+"(+n,i
• P+"ia"2i(i,
• Ga4al an(!n4
• An+mia
• P+"2a"a)an !,!,
• Pl+!"i(i,
• A,i2o,i,
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TERIMA
KASIH