LAPORAN KASUS GH.pptx

7/25/2019 LAPORAN KASUS GH.pptx

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LAPORAN KASUS GH

AKI ON CKD

DEVI NOVITA

C 111 10 313



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



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)



• 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



Ri=aa( So,ial

• Pa,i+n m+n4a! a2an4 min!m *am!2an oa( )+"al

• Ri=aa min!m min!man +",o2a



• 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



• 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+"



• 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;



HASIL PEMERIKSAAN LA. Tan44al 1$03$'016 8-o,( ("an,>!,i '!ni(

.C 16/0%R.C 3/1H. %/1HCT '&/'



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



•

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



TIN*AUAN PUSTAKA



AKI 8 ACUTE KIDNEF IN*URF



KLASIIKASI .ERDASARKA KLASIIKASI RILE



KLASIIKASI AKI .ERDASARKAN KDIGO'



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



KLASIIKASI .ERDASARKAN

ETIOLOGI

.+"2a,a"an +(iolo4i/ 2ia4i 3:

• P"a"+nal

•

R+nal• Po,( "+nal



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



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



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



PEMERIKSAAN PENUNJANG

• URINALISIS

• KIMIA DARAH• PEMERIKSAAN RADIOLOGI

• .IOPSI GIN*AL



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



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(



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/



CKD 8 CRONIC KIDNEFDISEASES



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+(+,



• 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 &#6

• 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



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



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



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



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,



TERIMA

KASIH

LAPORAN KASUS GH.pptx

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