dr .

Karina Dwi

Eng
Neige
 Hipertensi
↳ SKDI kompetensi 4

I DEFENISI
~

↳ 9 TD 3140190 MmHg

I .
ETIOLOGI

PRIMER : -

idiopathic
genetic
-

SEKUNDER i
-

CKD
-

pheochromasitoma ¥
- tumor adrenal
-

hipertirotd 1
NE E
I KCASIFIKASI ,

2%789%4
TNC ESC
normal < 120/80 420/80 optional

is:÷÷f÷÷ IF.im#nissi
'
ers:S , .

I 7160/100 2 1601100 I'

11 3 180/110 III

isolated hlpertension → hanga sista yg naik !

3140 / < go
I TERAPI HIPERTENSI

A kaptopr-u.lislnoppungiotens.in
Ce Inhibitor (ACE c ) Cupric ) →
- →

bkfanideaffn
Receptor Blocker CARB) -
o Cnsartan ) -

Ifa Blocker → ( uzosin ) b

-

prazosin . doxazos.in
( lol ) blsoprolol
Beta MESOPROIOI
ate no lol
n
→ its
, ,

Blocker non sekoktie -

b propanolof
' '

Selektif -
b meso -

Metro -
ate -
,
btw -

, ,
-

lupine )
.

-
b

Calsium channel Blocker ↳ amlodipin .

nieedlpin

hidrochlorohazid CHCT )
Diuretic
→

→ loop diuretic ( furosemide )

b
spironolactone
-

Tekanan Darrah
-

Cardiac
←
Output Cco)
petrie race raskucar Resistance

f f CCB

stroke volume Heart Rate r

L -

Blocker
B blocker ACE E
/
- -

ARB
ee

pretoad
diuretic
 TD 7140/90
t
Ada diabetes 1106K ?

I →
Ya 't) tidakf )

t t
1st ACE IIARB
-

1st tiaztd
2nd CCB / looked diuretic 2nd Ace -I/ARB

t t
target < 140/90 berapausia
pasion ?
← ↳
360 260

t t
<
15%0 44%0
\
 ftp.eiatensi
I
v

Peruana gayahidup

✓
I
TD 3140/90

- Wyatt
penyatithpengerta-0 penyerta

✓ I sestuaika dgnpenyakio
Ht Stg I Ht Stg I
r
106 at 206at

:::¥' :::÷::.:s%*
1st tiazid 1st tiazid t
ACEIIARB

HIPERTENSI t peng .
penyerta
-

pony . gTnyaL :
ACE -
I IARB
-
DM :
ACE I -
CARB
Angina pektoris p blocker ACE I IARB
'
-

CCB
-
:
, ,

-
CHF : diuretic (edema) ,
ACE IARB ( stake)
-

LVH :
ACE I
-

( ARB
-

Atrial frontage :
B blocker
Ibu tanto need crine metirdopa
C$¥I
-

:
,

BPH
I powder
-

: -
I
 HIPERTENSI KRIS IS
↳ TD 7180
MMH8/> 120 mmHg
Hipertensi Urgensi thperqonsi Emergensi

)
↳ Sawai ↳ dare rot
④
todgatnaodetamage
①

Target t TD IMAP 25% + Map 2506

dalam 240am dalam 22am
-

fatal aksana
-

oral
parenteral
captoprk SL
perdipine Needlpirie
. ,

dilliazem i nlhogbirepwi
-

END TARGET ORGAN DAMAGE

tkesadarcn
stroke → nyeri kepala ,
,

Keyong ↳ muntdppoyekho
b Mata Kasur
Retinopathy
-

perdarahan Retina

nyeri dada

ftp.C#EEBr
myocardinfatk →

pea's:
:* eras .

Paro → edema

Isa !
"

anuria , oliguria ,
th Ur , Cr

keening . mud ,

Mdneah
↳ definisi i
⑦
ABB
Mikio organismic di Sal .
kemih
ehologi : E. coli -
b Batang gram -0C> 00% )
S . aureus -
b gram ④
i
Pseudomonas → -

Pada kateter
Proteus sp → batu Strutt

A- egala Kunis i DEMAM ! !

- pyelonephritis
- demon
-

Nyeri ping gang

'
-

Maal Muntari
-

Pf : Nyeri ketok
CHA

end drank
Ti freku
,
,

heortaoy
-
cystitis
←
I
BAK)
-

disuriacnyeri
TY BA anyang 2am
-

④ uretrlhr BAK Adak lompiao

-

pf
-

:
Nyeri teton
J piura suprapubik
-

prostatitis
-
Ckenangnanah )
DRE : nyeri pd prostate
 PEM .
PENUNJANG

Urinalisa -
D leukosituria ( leukosit 751406 ) . bakteri ⑦
,

Marit nitrate nlrit

⑦ -
b -
b
T

Kultur URIs →
GOLD STANDARD
109¥
-

> 103 -
→ simptomatik
3105 → aslmptomatik

KLASIFCKASI
1 CSK Slniptomatih ④ gedda
!
.

aslmptomatin C- ) gegala to tidal poorly obat

2 ISK cystitis pyelonephritis f Adak homie

kompllkata
:
-

non ,
,
,

kompllkata r
.
15K
pd 0

ISK
pd anak
ISK pd of hamic
ISK pot kelainan Sal .
kemih
3 - ISK at i
pyelonefritir
ISK bawah : cystitis . prostatitis

TERAPI
Cystitis 1st line Kotrimoxazole 2x
960mg
: :

{ 2nd line Gol quinolone ciprofloxacin 24500mg

↳
: .
:

I :3 -

5 HARI levofloxacin 1×500 Mg

Os : 5-
7 hari
 f -7-10 her
:

Pyelonephritis : 1st line : Gol Qiunolon 18 :

10-14 hr

ciprofloxacin 2×500 My
}
-

Khari
↳ pd 7 -

PN berat to Rawat Thap

↳ aol.ceeacospop.in µ

Ibu Hamil :
Gol B lactam : amoksisilin , ampicillin ,
penicillin
cefalosporin i
cefadroxto ,
cefixtme ,

Anak kotrimoxazole 10mg 1kg BB Hari

'

Cdioagi 2 dosir )

Batu Saluran Kemih r

↳ Batu asan :
Batu radio laser
( as . urat . aram yengkolat )
Batu basa : Batu radio opaque -b Putih
( bare kalsium , balu staghorn ,
batu
Struve )
 -

- nefpeolltiasisr
-

nyeri pinggang ,

Meng alar keperut

i
PF nyeri ketok OVA
-

Jlkahidroneerosir
• =
↳ ballot@Ment

-
Urcoterohtiasis
Nyeri
-

pinggang ,

menoalarhingga ke
selangkangon Isoform
PF
Nyeri
-
:

¥
ketone CVA
- vesikolltiasir

Boff
• -

BAK

berubah
berhenti ,

posisi
sika
BAK

5mg
•

.at?scar-kem6aii-otidakbisaBAk,nyeRihe6at
ffuretroiin

PEMERIKSAAN PENUNDANG

Awal : urination b
-
hematuria to orthosis 75 llpb
- -
Kristal ⑦
[any Utah
B.NO/wp!RadioopaqRadiolusen,kontraindikaripdCr3k5
: BNO

USG Ginga :
acoustic Shadow
CT Scan : GOLD STANDARD
SEAMEN URIN

JARUM to atom urat

Prisma ( pet Mari

→
triple fosfat

→ 9h01 Rack
Cr > 115
x dupokai
b
-

←
 TATALAKSANA
1 .
NON FARMAKOLOGIS : konservatif :
hidrasi ,
bionat

2 . FARMAKOLOGIS : analgetik ,
spasmotitih ( x Blocker )
-

Ukuran Batu

E5 mm

konservatif
\ -
320mm

pembedahan
5- gmm
10 lgmm
CPCNL)
-

ESWL URS
 Nefrotik =
vs Nefieltik
-
BAK seperti
Gk :

Oedema daginsl

!
dnasarka -

Gross hematuria → avian

Cola
Hlpoalbuminemia ( < 3.5 ) -

thpertiensi
Proteinuria made ( t }¥f4zy , any
-
Rico .
bank pllek sblmnya ASPA
thperllpidemia -
Riw korengan
↳ Thad 7200 ,
To 7150
-

e proteinuria
1-
2)
ETIOLOGI i

PRIMER :
pd anak SS ) -
G- NAPS -
D Streptococcus B. Hemoliticvr
(minimal change D ) ↳ realest Hypersensitivity tie HI
Selander : nefropdti DM - LN is ANA ⑦

-
IgA here Ropati → biopsi
-

÷:÷÷÷:÷÷÷÷÷÷÷÷¥::÷
"

÷:÷: :*
-

...
Kelantan minimal

TREATMENT N - t -
11291kgBB that
d garam I girl keep Ihr
dict t Garam
y
non Farma ko i
: 016 -
018
,

protein normal d protein

FARMAko -
i kortlko steroid oral Antibiotic i 1ns -
penicillin
"
5Jut% , an

FUROSEMIDE alergi .
orllwmiswi 44500
-

ACE I -

( ARB
-

↳ anti proteinuria
 KHUSUS SIND ROM NEFROTIK

Tahap I i
Full dose ( 60 mglmyhariatauzmglkgB.rs/haRi )
( 4mg ) ↳ setiap hari
f) f) f)

Tahap II : alternate dose ( 40mg Im Hari '

atau 1.5
mg kg BB Inari )
↳
( 4mg ) selang seeing

KLASIFIKASI
Remisi proteinuria beirturue
' '
:
C- ) dlm 3ham

e) e)

Recaps proteinuria Ct) dim hari

'
i 3 berturut
scoring → 32×16 bulan -
D 34 X Ahn

Tarang
- b s
2×16 balan → < 4x Ahn

sensitive steroid → remisi SHH terapi tahap I

take
Resistant steroid
-
b Remisi stlh terai tahap I
•

↳ Thhlnosupresont :
Slklosporin ,
MME
 G-GOA vs
G6④
4lb ,
TG anuria ( oliguria → Uop :N
-
- 0.5 -

la/kgBB/gam
✓
,
✓
sedikie ) 30cL loan
N: < 50 < his ( BAK
Reversible

1
irreversible 720C

sepsis ,
CHF

ETIOLOGI :
pre renal -

bdehidrasi , prdrhn Perry . Kronig (DM ,

HT ) i

Renal b
-
lskemiic ( ATN ) Kel . Iain : - anemia
-

post Renal
-
b obstruksi -
Maal Muntean hereat
-
-
-
Koma uremlkim /
uremic ensefalopati
2
gatal
-

PEM PENUNJANG

Fungsi ginga 4 (N : Ur < 50 Crais ) Ur T G T

the normal :( kec perdarahom )
. HG slomgldl ( anemia )
USG Goyal

Global normal ( tidal Mengeat Ginga contracted lmengeai

feFR¥xBBY
KLASIFIKASI Wanta :X 0,85
-

RISK i T Cr 71154 72 x Cr

Injury : > 2X €790

Failure :
> 3X IT
,
60 -

89
anemia
Loss i
74 Minggo 30 -

59
→

End stage i 73 bulan ( CKD) IT

i
15 -

29
overload
'

✓ L 15 →
'

Cr -
-
I

✓
 µ
trainer
<7
TotalAksana AKI TATALAKSA NA CKD EPO
→ 77
-

RuyUk -

Anemia → EPO

-
Atasi peony .
dasan -
terapi penggannr ginga
HD ,
CAPP , transplantasr

IndiKasi HD Ato !
-

A i
Asidosis metabolite
(KU : sersaknaeas ,
Kuss Maul )
pH < 7,1

I i lntoksikasi
( mis :
Organofosfat )
Uremic syndrome lenseealopati
(Maal muntah heart ,
Kona ,

Keyong ,
Ureum 7200
)
E electrolyte
:
imbalance

hlpeorkalemia ( N : 3.5 -

5 ME
)
of K
↳ Es anemia
gaming
:

EKG :
T tall
T
th win
normal

0 : overload
edema Paro