PPK CKD Ada Tabel

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PANDUAN PRAKTIK KLINIS (PPK)

TATA LAKSANA KASUS

RSUDKOTA BEKASI

JAWA BARAT

2013 – 2015

CHRONIK KIDNEY DISEASE CHRONIK KIDNEY DISEASE

1.

1. PPeengngeerrtt!!n n ((DDe"e"nn##)) PPeenn$$!%!%t t ggnn&&!!' ' %%rrnn% % !!!!''!!* * ##++!!tt+ + ,,rr##ee# # ,,!!tt""##''gg## en

eng!n g!n etet''g g $!ng $!ng -er-er!g!!g!/ / eneng!%g!%-!t-!t%!n %!n ,en,en+r++r+n!nn!n "+ng# gn&!' $!ng ,rgre#"/ $!ng ter&! !'! !%t+  3 "+ng# gn&!' $!ng ,rgre#"/ $!ng ter&! !'! !%t+  3 -+'!n

-+'!n !n !n ,!! ,!! !%*rn$! !%*rn$! -er!%*r -er!%*r eng!n eng!n g!g!' g!g!' gn&!'.gn&!'. Se'!n&+tn$!/ g!g!' gn&!' !!'!* #+!t+ %e!!!n %'n# $!ng Se'!n&+tn$!/ g!g!' gn&!' !!'!* #+!t+ %e!!!n %'n# $!ng t!n! eng!n ,en+r+n!n "+ng# gn&!' $!ng rreer#-e'/ t!n! eng!n ,en+r+n!n "+ng# gn&!' $!ng rreer#-e'/ ,!!

,!! #+!t+ #+!t+ er!&!t er!&!t $!ng $!ng eer'+%!n eer'+%!n ter!, ter!, ,engg!nt!n,engg!nt!n gn&!' $!ng tet!, -er+,! !'$## !t!+ tr!n#,'!nt!# gn&!'. gn&!' $!ng tet!, -er+,! !'$## !t!+ tr!n#,'!nt!# gn&!'.

De"n# KD en+r+t NK4K6DO7I !!'!*8 De"n# KD en+r+t NK4K6DO7I !!'!*8 1.

1. Ker+#Ker+#!%!n gn!%!n gn&!' #e&!' #e'!!  '!!  3 -+'!n3 -+'!n 9!n

9!ng g !%#!%#+ + terter!,!!,!t t %er%er+#!+#!%!n %!n gngn&!' &!' !!'!!'!* !* -'-'!! &+,! %e'!n!n #tr+%t+r !t!+ "+ng# gn&!' eng!n !t!+ &+,! %e'!n!n #tr+%t+r !t!+ "+ng# gn&!' eng!n !t!+ t!n,! ,en+r+n!n :4R/ en

t!n,! ,en+r+n!n :4R/ eng!n #!'!* #!t+ !n"e#t!#8g!n #!'!* #!t+ !n"e#t!#8

--

Ke'!n!n ,!t'gKe'!n!n ,!t'g

--

PePet!t!nn! ! %e%er+r+#!#!%!%!n n ggn&n&!'!'/ / teterr!#!#+% +% %e%e'!'!nn!n!n

%,## !r!* !t!+ +rne/ !t!+ %e'!n!n r!'g. %,## !r!* !t!+ +rne/ !t!+ %e'!n!n r!'g. 2.

2. :4:4R R ; ; <0 '6<0 '6een6n61/1/=3=322_{ 3 -+'!n eng!n !t!+ t!n,!}_{ 3 -+'!n eng!n !t!+ t!n,!}

%er+#!%!n gn&!'. %er+#!%!n gn&!'.

2

2.. AAnn!!nnee#### 11.. KKee''++**!!n n ,,!!! ! KKD D 8 8 ''ee!!**/ / ''eett!!rrgg/ / !!nnrree%%##!!/ / ++!!'' +nt!*/ n%t+r!/ g!t!'/ #!%t %e,!'!/ g!ngg+!n t+r/ +nt!*/ n%t+r!/ g!t!'/ #!%t %e,!'!/ g!ngg+!n t+r/ #e#!% n!"!#/ n$er !!/ "!tg+e/ ,!n!ng!n %!-+r/ #e#!% n!"!#/ n$er !!/ "!tg+e/ ,!n!ng!n %!-+r/

25 25

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#"+ng# ere%#/ *,erten#/ ,er!r!*!n/ %e&!ng/ n$er #en/ t+'!ng !n "r!%t+r/ g!ngg+!n ent!'.

3. Peer%#!!n 4#% 1. KU 8 !,!t ter&! ,en+r+n!n %e#!!r!n #!,! %!/ ,+>!t/ #e#!% n!"!#.

2. ?!t! 8 ,en+r+n!n #+#/ red eye, n#t!g+#/ ,+,' !#etr.

3. Le*er 8 ,e-e#!r!n %e'en&!r tr.

@. P!r+ 8 :er!%!n n!"!# tertngg!'/ retr!%# ()/ SN e'e!*/ ,e%!% r*n% ().

5. K 8 ,e-e#!r!n &!nt+ng (!,!t%!n ,erge#er!n !r -!t!# &!nt+ng/ %*+#+#n$! ,erge#er!n -!t!# &!nt+ng

%r %e !r!* '!ter!'.)/ g!ngg+!n r!! &!nt+ng (!rt!)/ ,enng%!t!n te%!n!n !r!*.

<. A-en 8 n$er e,g!#tr+/ !#te#.

=. ?+#%+'#%e'et!' 8 n$er #en/ t+'!ng !n "r!%t+r. C. E%#tret!# 8 ne+r,!t ,er"er/ ,ttng ee. . K+'t 8 %erng/ -er##%/ #>r!t>* !r%/ urea frost @. Krter! D!gn## 1. Ker+#!%!n gn&!' #e'!!  3 -+'!n eng!n !t!+ t!n,!

#ert! ,en+r+n!n :4R

2. :4R ; <0 '6en61/=32  3 -+'!n eng!n !t!+ t!n,! %er+#!%!n gn&!'.

5. D!gn## Ker&! KD (Chronik Kidney Disease) <. D!gn## B!nng 1. AKI ( Acute Kidney Injury)

2. Snr! Ne"rt% =. Peer%#!!n Pen+n&!ng Pemeriksaan laboratorium :

1. 4!!' gn&!'

2. D!r!* 'eng%!, ( ter!#+% %! !r!*) 3. Urn!'#!

@. :4R

Pemeriksaan penunjang lain :

1. 4t ,'# !-en 2. BNOIP

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3. Pe'gr!" !ntergr! 6 retrgr! @. US:

5. Rengr!

<. B,# !n ,eer%#!!n *#t,!t'g gn&!' C. Ter!, Prinsip terapi

1. Ter!, #,e#"% ter*!!, ,en$!%t !#!rn$!

2. Pen>eg!*!n !n ter!, ter*!!, %n# %r- 3. ?e,er'!-!t ,er-+r+%!n ( progression) "+ng#

gn&!'

@. Pen>eg!*!n !n ter!, ter*!!, ,en$!%t %!r!#%+'!r

5. Pen>eg!*!n !n ter!, ter*!!, %,'%!#

<. Ter!, ,engg!nt gn&!' -er+,! !'## !t!+ tr!n#,'!nt!# gn&!'

erapi Konser!ati"

• Pengobatan #ipertensi. T!rget ,en+r+n!n te%!n!n !r!* $!ng !n&+r%!n  1@060 Fg. D!,!t -er%!n AE In*-tr !n ARB.

• Pembatasan asupan protein/ +'! %et%! L4: ;<0 '6ent. J+'!* !#+,!n ,rten $!ng !n&+r%!n 0/<0/C gr6%gBB6*!r/$!ng 0/350/5 gr  !nt!r!n$! er+,!%!n ,rten eng!n n'! -'g tngg. P!! ,!#en $!ng #+!* ene%!t #t!+ !%*r/ !#+,!n ,rten tng%!t%!n en&! 0/ g6%gBB6*!r $!ng

terr !r ,rten eng!n n'! -'g tngg.

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• Retriksi "os"or/ !t!# eng!n e-!t!# et "#"!t/ $!t+ #e-!n$!% <00C00 g6*!r. ?e-er ,eng%!t "#"!t. 9!ng -!n$!% ,!%! !!'!* !O3 !n !'>+ !#et!t.

• $engurangi proteinuria. D!'! *!' n AE n*-tr !t!+ ARB -!#!n$! g+n!%!n. D!,!t &+g! %-n!# !r AE In*-tr !n ARB. J%! te+%!n ,enng%!t!n e"e% #!,ng !%! -!t -#! g!nt eng!n 'n %e+! #e,ert B/ 't!Ge/ er!,!'.

• $engen%alikan #iperlipi%emia. Det $!ng -er%!n #e-!%n$! eng!n+ng %+r!ng !r =H %!'r 'e!% &en+*6#!t+re "!t (SA4A)/ ,'$+n#!t+re "!t (PU4A) *ngg! 10H/ n+n#!t+re "!t (?U4A) *ngg! 20H !n tt!' 'e!% 2535H !r %!'r tt!'. Det &+g! *!r+# eng!n+ng %!r-*r!t %,'e%#(50<0H !r %!'r tt!') !n #er!t (2030 g6*!r). K'e#ter' et *!r+# %+r!ng !r 200 g6*!r. Ter!,

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"!r!%'g# !,!t -er%!n -!t g'ng!n St!tn !n "-r!t.

• Pembatasan &airan 'balan&e &airan( %an elektrolit/ J+'!* !r $!ng %e'+!r !r t+-+* $!t+ !r insensible water loss !!'!* #e%t!r 500C00 '6*!r/ #e*ngg! &+'!* !r $!ng !#+% !!'!* 500C00 '6*!r t!-!* &+'!* +rn. A#+,!n >!r!n 12 L ,er *!r !,!t en&!g! %e#e-!ng!n >!r!n. Pe-!t!#!n e'e%tr't/ $!t+ eng!n eng!!# !#+,!n %!'+ !n n!tr+. K!'+ -!t!# %!ren! *$,er%!'e! !,!t en$e-!-%!n !rt! &!nt+ng/ #e*ngg! -!t-!t!n !n !%!n!n $!ng tngg %!'+ *!r+# -!t!#.(2)_{J%! :4R en+r+n 1020}

'6ent !%! !#+,!n *!r+# %+r!ng !r 50<0 e6'.

• Anemia/ EPO -!#!n$! -er%!n #e-!g! n&e%# #+-%+t!n (25 *ngg! 125 U6%gBB) tg! %!' #engg+.

In%!# ter!, eng!n ertr,etn !!'!* %!!r F-  10 gr H eng!n ,en$e-!- '!n #+!* !t!#.

• Asi%osis) Pen+r+n!n !#+,!n ,rten !,!t e,er-!% %e!!!n !###/ tet!, -'! %!!r -%!r-n!t #er+ %+r!ng !r 15 E6'/ !,!t -er%!n n!tr+ -%!r-n!t !+,+n #tr!t ,!! ## 1 E6%g6*!r #e>!r! r!'. A### -er!t %re%# eng!n N!FO3 ,!renter!'.

• Hiperkalemia) !,!t -er%!n :K!'#+ g'+%n!# 10H 10 ' !'! 10 ent I/ B%!r-n!# n!tr%+# 50150 I !'! 1530 ent/ In#+'n !n g'+%#! <U n#+'n !n g'+%#! 50g !'! !%t+ 1 &!)

K!$e!'!te (re#n ,eng%!t %!'+) 2550 gr r!' !t!+ re%t!'.

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• Hiperurisemia)A',+rn' #e-!%n$! -er%!n 100 300 g/ !,!-'! %!!r !#! +r!t  10 g6' !t!+ !,!-'! ter!,!t r!$!t g+t.

• In"eksi) Penert! g!g!' gn&!' %rn% e'% %erent!n!n $!ng 'e-* tngg ter*!!, n"e%#/ ter+t!! n"e%# #!'+r!n %e*. D!,!t -er%!n !nt-t% >e"!'#,rn gener!# %e 3/ #e,ert >e"tr!n/ !n >e",er!Gn/ $!ng eer'+%!n ,en$e#+!!n ##.

$o%i"ikasi pen*esuaian obat

• ?eng*n!r -!t-!t!n $!n e'n!# ter+t!! e'!'+ gn&!'. Se,ert ?et"rn/ e,ern/ !n OFO '!n $!ng e'n!#  gn&!'. OAINS &+g! *!r+# *n!r %!ren! !,!t e,er-+r+% "+ng# gn&!'. D!n -!n$!% !nt-t%/ !nt!rt! / !n !nt*,erten# $!ng eer'+%!n ,en$e#+!!n ##.

erapi penggantian ginjal+

1. Fe!'#! !t!# n%!#. 2. D!'## ,erne!' !t!# n%!#. 3. Tr!n#,'!nt!# gn&!'.

. E+%!#

(Hospital Health ro!otion)

1. Pen&e'!#!n ,er&!'!n!n ,en$!%t/ %,'%!#/ ren>!n! ,er!!t!n !n tn!%!n.

2. Pen&e'!#!n tn!%!n ter!, ,engg!nt gn&!'/ ter!#+% %,'%!#.

3. Kn#+'t!# :G.

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5. Pr>e S/ W'#n L. P!t"#'g Kn#e, K'n# Pr#e#,r#e# Pen$!%t/'.2. E:. J!%!rt!M 2011.