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7/21/2019 Interpretasi Data Klinik Gangguan Ginjal
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Oleh :Ritha widya S.Si,MARS,Apt
PROGRAM STUDI PROFESI APOTEKERFAKULTAS FARMASI
UNIVERSITAS ! AGUSTUS "#$ %AKARTA
7/21/2019 Interpretasi Data Klinik Gangguan Ginjal
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LATAR&ELAKANGKe'(t(ha) *e+a)- Ap+tee aa) pe/aha/a)/e)-e)ai data li)i ()t( dapat /ela(a)
ti)daa) e0a/a*ia) de)-a) tepat *e*(aide)-a) t(1(a) teapi
&UKAN UNTUK MENDIAGNOSA
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Ti)1a(a) data li)i -i)1alO-a)+lepti* (i) : 2a)a da) &a( (i)
Pe/ei*aa) i/ia (i): Gl(+*a, A*et+),
&ili('i), Daah,&eat %e)i*, P+tei),p3Mi+*+pi (i) : *ili)de da) *el
Ki/ia daah : eati)i), &UN
Pe)ilaia) 0()-*i -i)1al : 4lta*i da) t('(l(*
Ti)1a(a) pe/ei*aa) adi+l+-i
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ORGANOLEPTIS URIN
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2ARNA URINN+/al : 1e)ih *ediit 'ea'(t da) 'ewa)a
()i)-,
i)te)*ita* wa)a li)ie de)-a) pe)i)-ata)+)*e)ta*i
Kee(ha) : i*tali*a*i (at50+*0at
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2ARNA URIN
Meah
Pat+l+-i : 3ae/+-l+'i)
N+) pat+l+-i : +)*(/*i +'at, 6at wa)aOa)ye
Pat+l+-i : Pi-/e) e/ped(, 'ili('i)
N+) pat+l+-i : pe)--()aa) +'at ISK, piidi(/
K()i)-
Pat+l+-i : 'ili('i), (+'ili('i), (i) peat
N+) pat+l+-i: w+tel, )it+0(a)ti+)
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2ARNA URIN 78+)td..93i1a(
Pat+l+-i : 'iliedi), 'atei 7p*e(d+/+)a*9
)+) Pat+l+-i : ita/i), +'at p*i+aati0, di(e*i*
&i()+) pat+l+-i : di(eti, )it+0(a)
8+lat
pat+l+-i : pi-/e) e/ped(
)+) pat+l+-i : le+d+pa, )it+0(a), *(l0a3ita/5hita/ e;+lata)
Pat+l+-i : (+'ili)+-e)
)+) pat+l+-i : +/ple* 'e*i, 0e)+l
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&AU URIN
N+/al : *ediit 'e'a(
&a( a*et+) pada dia'ete* et+a*id+*i*,
&a( a/+)ia i)0e*i 'atei 7(ea a/+)ia9
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KIMIA URIN
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PEMERIKSAAN KIMIA
URINGl(+*a N : )e-ati0
A*et+) N : )e-ati0
&ili('i) N: )e-ati0
Daah N : )e-ati0
P+tei)
&eat %e)i*p3
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PROTEINURIA
Ke'eadaa) p+tei) di dala/ (i)
P+tei) (/(/)ya /e(paa) *e)yawade)-a) &M 'e*a, *ehi)--a pada eadaa))+/al *(lit dapat te4lta*i +leh -l(/e(l(*
P+tei) apa'ila te4lta*i /aa aa)teea'*+'*i e/'ali e *i(la*i *i*te/i
U1i dip*ti : < = ># 7># /e)()1(a)+)*e)ta*i p+tei) ya)- ti)--i9
U1i la' : (a)titati0 de)-a) i)*t(/e)
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KENAPA &ISA TER%ADI
PROTEINURI ???
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MEKANISME
PROTEINURIA• F()-*i+)al
Te1adi pada -i)1al )+/al, ae)a : +lah a-a
'eat, de/a/, pe)i)-ata) ee*i p+tei)ae)a 'edii la/a
• Alia) pa e)al
Pe)i)-ata) ada p+tei) 'e &M e)dah ya)-
dii(ti de)-a) pe)i)-ata) 'e'a) 4lta*i-l(/e(l(* ea'*+'*i p+tei)
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MEKANISMEPROTEIN....;+)tdGl(/e(l(*
&eaita) de)-a) pe)yait -l(/e(l(* e@.
-l(/e(l()e0iti* T('(l(*
U/(/)ya p+tei)(ia 'eat ae)a e(*aa)t('(l(*, e@. pyel+)e0iti* da) )e+*i* t('(l(*
a(t.
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KLASIFIKASI
PROTEINURIAP+tei) <,$ -5h
OR 'eat, *te**, hipet)*i dll
P+tei) *eda)- <,$=B -5 haiGN +)i*, )e0+pati dia'ete*, pe ela/*ia
P+tei) &eat C B -5hai
GN a(t, GN +)i* 'eat, )e0+pati 'eat
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p3 URIN
p3 (i) dewa*a )+/al : $ = ,$ , ata :
p3 (i) a*a/ :
Ke(*aa) 1ai)-a), diet hewa)i, a*id+*i*/eta'+li5e*piat+i, de/a/
p3 (i) 'a*a :
Diet *ay(a) '(ah, ISK
7p*e(d+/+)a*5p+te(*9, *(*(Pe)-a(h a*(pa) tehadap ea*a/a) dapat
'e/a)0aat dala/ teapi 'at( -i)1al
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&at( ya)- *i0at)ya a*a/ : al*i(/ +*alat,a*a/ (at5*i*tei)
&at( ya)- *i0at)ya 'a*a : al*i(/ 0+*0at5/a-)e*i(/ a/+)i(/ 0+*0at
URIN ASAM DAPAT MENGOBATI BATU GINJAL BASA
URIN BASA DAPAT MENGOBATI BATU GINJAL ASAM
Pada penderita batu ginjal!eberadaan
!"n#tituen ter#ebut didala$ urin dapat
$e$pridi!#i!an adan%a jeni# !ea#a$an batu
ginjal
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&ERAT %ENIS URINPe)-((a) de)-a) (i)+/ete ()t(
/e)e)t(a) +)*e)ta*i (i)
&1 (i):
N+/al : ,<<=,<B$Di'ei /i)(/ 'a)ya : ,<<
Ke(a)-a) ;aia) : ,<#
BJ urin perlu $e$perti$bang!an a#upan
untu! $engeta&ui !e$a$puan pe$e!atan urin
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MIKROSKOPIK URIN
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UNSUR=UNSUR A&NORMAL
URINE Sel=*el
Sile)de
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SILINDER
Ma*a p+tei) 'e'e)t(
*ili)di* ya)- te'e)t(dit('(l(* -i)1al da)
di'ila* /a*( e dala/(i)
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%e)i*=1e)i* *ili)deSili)de di'a-i 'eda*aa) 'e)t()ya :
Sili)de hiali) OR 'eat
Sile)de *el daah /eah
-l(/e(l(*)e0iti*Sili)de *el daah p(tih ISK5pyel+)e0iti*
Sili)de *el epitel t('(l(* )e+*i* t('(l(*
Sili)de 'atei ISK5pyel+)e0iti*
Sili)de le/a 7'ada) +al9 p+tei)(i5)e0+ti *i)d+/
Sili)de -a)(la -a-al -i)1al
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SelNe(t+4l i)0e*i
E+*i)+4l i)0e*i
Li/0+*it ada)ya e*i pe)+laa) padap+*e* ta)*pla)ta*i
Sel epitel -a)--(a) t('l(*
Eit+*it e(*aa) -l(/e(l(*
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KIMIA DARA3
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&LOOD UREA NITROGEN7&UN9Nit+-e) (ea /e(paa) p+d(
/eta'+li*/e p+tei)
&UN N+/al : < < /- 5 << /lK+)*e)ta*i te-a)t()- dai a*(pa)
Apa'ila GFR t(() te1adi pe)i)-ata) &UN
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KREATININKeati)i) /e(paa) p+d( /eta'+li*/e
+t+t
Te4lta*i +leh -l(/e(l(*, teee*i dala/'e)t( (t(h, teea'*+'*i *e'a-ia) e;ildala/ -i)1al
Keati)i) *e(/ )+/al : <,!=,$ /-5<< /l
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PENILAIAN FUNGSIGIN%ALF()-*i 4lta*i
F()-*i t('(l(*
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GLUMERULUS FILTRATE RATE
7GFR9Ke/a/p(a) -l(/e(l(* dala/ /e/4lta*i
la(ta)
Met+de :
Medi;al A)i/ati+) Kid)ey F();ti+) i) Filte,i)- 8+)t,a*t.H
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INULIN KLIRENSSi0at :
Se)yawa P+li*aaida 0(t+*a
Tida teiat p+tei) pla*/a, Tida te*ee*i da) tida teea'*+'*i
Tida te/eta'+li*/e +leh -i)1al
I)(li) di'eia) /elal(i tete*a) IV +)*ta) (5
/e)1a/i) ete*ediaa) didala/ pla*/a ya)-+)*ta)
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INULIN KLIRENS
GFR = Kli in = (U in x V) / P in
U i) : +)*e)ta*i i)(li) dala/ (i) 7/-5dl9
P i) : +)*e)ta*i i)(li) dala/ pla*/a 7/-5dl9
V : V+l(/e (i) 7 /l5/e)it9
Kl i) : lie) i)(li) 7 /l5/e)it9
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KREATININ KLIRENS8+;+0t da) Ga(lt :
Pia : Kl J 7#<=(/(9 @ && 5 7! S 9
2a)ita : Kl @ <,$
%ia +'e*ita* && di-a)ti de)-a) I&2I&2 :
Pia $< >7,B @ ele'iha) ti)--i $ 0eet dl/ i);hi9
2)t #$,$ > 7,B @ ele'iha) ti)--i $ 0eet dl/ i);hi9
'et ( 'l !r ( !reatini !liren# )$l*$enit+
U$ur ( ta&un
IB, ( ideal b"d% -eig&t )!g+
Sr !r ( #eru$ !reatinin
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E*ti/ate Re)al F();ti+)Modifed Diet in Renal Disease (MDRD)
GFR (mL/min/1.73 m ) = 1!" x #$%& '
1.1 x (*+e) ' ,.,3 x (,.7 i- -emale)x (1.1, i- *-%ian ' *me%ian)
S8: *e(/ ;eati)i)e i) /-5dL a-e i) yea*
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*+alI'( *+/ad (/( B tah(), 'eat 'ada) #<
- , /e)-el(h )yei (i)a*i, *etelah di ;eeati)i) *e(/ )ya *e'e*a : <,# /-5dl.
&eapaah lie)* i'( *+/ad ?
8;l J7#<=B9 @ #< @ <,$
! @ <,#
<!,B /l5/e)it
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GFRStage Description GFR
ml/min/1.73m²
Action*
1 Kidney damage witnormal or !GFR
" #$.$ Diagnosis ant treatment%
&reatment o' comor(idconditions.
Slowing progression.
)D ris+ red,ction
- Kidney damage witmild GFR
$0#2stimating progression
3 oderate GFR 3$04# 25al,ating and treatingcomplications
6 Se5ere GFR 140-# reparation 'or +idneyreplacement terapy
4 Kidney 'ail,re
8 ESRD9:14 8 or dialysis9 Replacement 8 i'
,remia present
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TEST FUNGSI TU&ULUSU)t( /e)-etah(i 0()-*i t('(l(*
Met+de :
Te* PSP Te* Paa a/i)+h(tiat 7PA39
Te* pe/eata) da) pe)-e);ea)
Te* pe)-a*a/a) (i)
Te* +)*ea*i )ati(/
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NILAI NORMAL URINALISALe(+*it : <=# 5 LP&
Sel epitel : <=$ 5LP&
&atei : <
&ada) le/a +al : <Sili)de : <= 5 LP& 7hiali)9
Gl(+*a : )e-ati0
Ket+) : )e-ati0
Eit+*it : <= 5 LP&Le(+*it : <=# 5 LP&
Spe/at+6+a : > 7lai=lai9
Le)di
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PEMERIKSAAN
RADIOLOGI
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Piel+-a/ I)tae)a 7IVP9
U)t( /elihat elai)a), *epeti : at+4 -i)1al,piel+)e0iti*, da) -a/'aa) p+*i*i *etae'eadaa) -i)1al
Met+de : 0+t+ p+l+* adi+-a4 a'd+/e) pe)y()tia) /edia +)ta* di*()tia) *e;aa dila(a) pe/+teta) tiap /e)it pada $/e)it peta/a
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Ulta*+)+-a4 Gi)1al
Me/'edaa) t(/+ padat de)-a) i*ta ya)-/e)-a)d()- ;aia)
U(a) -i)1al
Ada)ya +'*t(*i
Ada)ya pe)+laa) -i)1al pada pe);a)-+a)
Me)e)t(a) leta -i)1al pada p+*e* 'i+p*i
-i)1al
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Radi+)(lida 7i*+t+pi9
Me)--()aa) pe)y()tia) adi+ati0 ()t(/elihat p+*e*=p+*e -i)1al 7 4lta*i, *ee*i,ee*i, -a)--(a) di0(*i 9
&ia*a di-()aa) ()t( /elihat e0eti4ta*e1a -i)1al *etelah pe);a)-+a)
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8T= S;a)
Me/pelihata) -a/'aa) /eli)ta)-
Me)--a/'aa) *e;aa teliti *el((h *i*te/(i)ai(*
Pe)etapa) *tadi(/ )e+pla*/a
Dapat /e/pelihata) 'at( pada ta;(*(i)a(*
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MRI&e0()-*i *a/a *epeti 8T=*;a), )a/()/et+de i)i tida /e/'(t(ha) pa1a)a)adia*i i+)
Me/'eia) -a/'aa) le'ih i);i di'a)di)-8T=*;a)
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&IOPSI GIN%ALU)t( /e)dapata) *pe*i/e) 1ai-a) -i)1al,ya)- e/(dia) *pe*i/e) dipeia* de)-a)/i+*+p ;ahaya, elet+) da)
i/()+H(e*e)
8(plia) dia/'il /elal(i 1a(/ ya)-di*()tia) eaah -i)1al de)-a) /et+deh(*(* da) dila(a) +leh ahli )e0+l+-i
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TERIMA KASI3