BAGIAN ILMU PENYAKIT PENYAKIT DALAM
LAPORAN KASUS
FAKULT FAKULTAS AS KEDOKTERAN
JUNI 2015
UNIVERSITAS HASANUDDIN
ACUTE KIDNEY INJURY PRE RENAL DD/ ACUTE ON CKD DD/ CKD GRADE 5
DISUSUN OLEH :
Reza Kur!a"a Ar#a $111 11 2%&
PEMBIMBING :
'r( )!"! E*!+a#! S(
DIBAWAKAN DIBAWAKAN DALAM RANGKA R ANGKA KEPANITERAAN KLINIK KLIN IK BAGIAN PENYAKIT DALAM FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASSAR 2015
1
LEMBAR PENGESAHAN
Ya, Ya, -er#a'a #a,a '!-a"a. !! /e+a#aa -a."a
Na/a
Reza Kur!a"a Ar#a Ar#a
N!/
$ 111 111 11 2%&
U!er3!#a3
U!er3!#a3 Ha3au''!
Ju'u* La4ra Ka3u3 Ac!" K#$%"& I%'(& P(" R"%)* E! C)+) D",#$()+# DD/ Ac!" -% -% CKD DD/ CKD G()$" G()$" 5.
Te*a. e*a. /e+e*ee /e+e*ee3a! 3a!a a #u,a3 #u,a3 e4a! e4a!#era #eraa a *!! *!! 4a'a 4a'a Ba,!a Ba,!a Pe+a!# Pe+a!# Da*a/ Da*a/ Fau*#a3 Ke'#era U!er3!#a3 Ha3au''!(
Maa3ar6
D!3u3u O*e.
Ju! 2015
Re3!'e Pe/-!/-!,
R") K(%#))% A(!)
2$(. W## E*#&)%!# S.
Re3!'e Ba7a
Dr( Juar'!
2
LEMBAR PENGESAHAN
Ya, Ya, -er#a'a #a,a '!-a"a. !! /e+a#aa -a."a
Na/a
Reza Kur!a"a Ar#a Ar#a
N!/
$ 111 111 11 2%&
U!er3!#a3
U!er3!#a3 Ha3au''!
Ju'u* La4ra Ka3u3 Ac!" K#$%"& I%'(& P(" R"%)* E! C)+) D",#$()+# DD/ Ac!" -% -% CKD DD/ CKD G()$" G()$" 5.
Te*a. e*a. /e+e*ee /e+e*ee3a! 3a!a a #u,a3 #u,a3 e4a! e4a!#era #eraa a *!! *!! 4a'a 4a'a Ba,!a Ba,!a Pe+a!# Pe+a!# Da*a/ Da*a/ Fau*#a3 Ke'#era U!er3!#a3 Ha3au''!(
Maa3ar6
D!3u3u O*e.
Ju! 2015
Re3!'e Pe/-!/-!,
R") K(%#))% A(!)
2$(. W## E*#&)%!# S.
Re3!'e Ba7a
Dr( Juar'!
2
LAPORAN KASUS Ac!" K#$%"& I%'(&
IDENTITAS PASIEN :
Na/a
T( 8
Ta,,a* Ta,,a* La.!r
219&91:5;
RM
020<1=
Peer>aa
)!ra3"a3#a
A*a/a#
Be
S#a#u3 Pera"!a Ka"!
ANAMNESIS
KELUHAN UTAMA Mu#a.9/u#a. ANAMNESIS TERPIMPIN Pa3!e 'a#a, e ru/a. 3a!# 'e,a e*u.a /u#a.9/u#a. +a, '!a*a/! 3e>a 1 /!,,u 3e-e*u/ /a3u ru/a. 3a!#( Mu#a. '!3er#a! ra3a /ua*6 ?reue3! 192 a*! 'a*a/ 3e.ar!( Mu#a.9/u#a. '!ra3aa /e/-era# .ar! !!6 /u#a. @10 a*!6 #!a4 a*! /aa 'a /!u/( R!"a+a# /e,3u/3! >a/u9>a/ua area +er! 4a'a *u#u# 'a ra3a ra/ 4a'a #u,a!( R!"a+a# /!u/ a#a3!'a 3aa# 4a3!e /u#a.9/u#a. 'a*a/ 3e/!,,u #e#a4! #!'a a'a 4eru-a.a( N+er! u*u .a#! #!'a a'a6 ra3a #er-aar '! 'aera. 'a'a #!'a a'a6 a 'a6 ra3a #!'a +a/a 4a'a 4eru# -a,!a a#a3 '!e*u.a 4a3!e( Mu#a. !3! /aaa6 #!'a a'a 'ara.( R!"a+a# /aa, #!'a a'a( Bua, a!r e7!* e3a -erura,( Bua, a!r -e3ar -!a3a6 7*a#( R!"a+a# -ua, a!r -e3ar .!#a/ '!3a,a*( De/a/ #!'a a'a6 r!"a+a# 'e/a/ '!3a,a*( Sa!# e4a*a a'a6 a3u4a /aaa /euru( Ba#u 'a 3e3a #!'a a'a(
=
R!"a+a# Pe+a!# Se-e*u/+a R!"a+a# D!a-e#e3 /e**!#u3 a'a 3e>a 1 #a.u *a*u6 GDS -!a3a+a 200
−
/,'* /!u/ /e#?r/! 500 /, 21 'a ,*!/e4!r!' 2 /, 11 'a '!/!u/ #!'a #era#ur( R!"a+a# H!4er#e3! a'a 3e>a 1 #a.u +a, *a*u6
−
#eaa 'ara.
-!a3a+a 1&0:0 //H,6 /!u/ a/*'!4!e 5 /, 116 '!/!u/ #!'a #era#ur(
−
R!"a+a# 4e+a!# >a#u, '!3a,a*
−
R!"a+a# #rau/a e4a*a '!3a,a*
−
R!"a+a# Pe+a!# 'a*a/ e*uar,a R!"a+a# 'a*a/ e*uar,a /e/!*!! '!a-e#e3 /e**!#u3 #!'a a'a( R!"a+a# Ga+a H!'u46 Mer #!'a a'a6 A*.* #!'a a'a(
PEMERIKSAAN FISIK :
Kea'aa u/u/ Sa!# Se'a, G!z! $uu4 $/43/e#!3 Teaa Dara. 1;0100 //H, Pera4a3a
20 a*! /e!#
Na'! :2 a*! /e!# Su.u =;6
T!,,! Ba'a 1;= 7/
IMT 2265 ,/2
Bera# Ba'a
S#a#u3 G!z! $uu4
;0 ,
K")*):
Uura
Nr/7e4.a*
Be#u
Me37e4.a*
De?r/!#a3
T!'a a'a
S!/e#r!3 /ua
S!/e#r!3 !r! 3a/a 'e,a aa
Ra/-u#
Suar '!7a-u#
M)!):
E3?#a*/u3
T!'a a'a
E4#a*/u3
T!'a a'a
K>u,#!a
T!'a ae/!3
Krea
Re?*e3 rea a'a
S*era
#!'a a'a !#eru3
Pu4!*
I3r 2(5 //2(5 // &
T"*#%):
Pe'e,ara
Pe/er!3aa #!'a '!*aua
O#rr.ea
Pe/er!3aa #!'a '!*aua
H#$%:
E4!3#a3!3
T!'a a'a
R.!rr.ea
T!'a a'a
M*!:
B!-!r
T!'a er!,
L!'a.
T!'a #r
T3!*
T19T1 T!'a H!4ere/!3
Far!,
T!'a H!4ere/!3
L","(:
Tu/r
T!'a a'a
De!a3! Traea
T!'a a'a
Ke*e>ar Ge#a. Be!,
T!'a a'a 4e/-e3ara
Ke*e>ar G'
T!'a a'a 4e/-e3ara
De3aa Vea Se#ra*
R0 7/H2O
Kau u'u
T!'a A'a
D)$):
Be#u
S!/e#r!3 !r! 3a/a 'e,a aa
Bua. 'a'a
Da*a/ -a#a3 r/a*
Se*a !,a
S!/e#r!3 !r! 3a/a 'e,a aa
P*3-:
Pa*4a3!
Fre/!#u3 3!/e#r!3 !r! 3a/a 'e,a aa
Peru3!
Ba#a3 4aru .e4ar I$S VI 'e3#ra Ba#a3 4aru -e*aa, aa I$S I Ba#a3 4aru -e*aa, !r! I$S
Au3u*#a3!
Bu+! Pera4a3a Bu+! Ta/-a.a
Ve3!u*er R.! 'a ).eez!, 9
J)%!%:
5
I34e3!
I7#u3 7r'!3 #!'a #a/4a
Pa*4a3!
I7#u3 7r'!3 #!'a #era-a
Peru3!
Ba#a3 a#a3 I$S III 3!!3#ra Ba#a3 aa *!ea 4ara3#era*!3 'e3#ra Ba#a3 !r! *!ea /!'7*a!7u*ar!3 3!!3#ra
Auu*#a3!
Bu+! >a#u, III /ur! re,u*er B!3!, >a#u, #!'a a'a
A4$-3"%:
I34e3!
Da#ar6 !u# ,era a4a3
Pa*4a3!
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Peru3!
T!/4a!
Au3u*#a3!
Per!3#a*#! a'a6 e3a r/a*
E+!("3#!)+:
T!'a a'a e*a!a(
PEMERIKSAAN PENUNJANG : L)4-()!-(#3 : 1. D)(), R!#%
NO 1( 2( =( &( 5( ;( <( %( :( 10( 11(
ITEM )B$ HPLT M$V M$H$ M$H Neu# L+/4. M3!# E Ba3
NILAI 1:( 10 = //= 116< ,'L &<1(10 = uL %=6% ?L ==6<: 'L 2%6= 4, %<6; < &62 06< 065
2. G*) D)(),
NO 1(
ITEM GDS
NILAI 2<& /,'L
;
6. K-)*)+#
NO 1( 2( =(
ITEM PT INR APTT
NILAI 1&6& 161: 2<6<
ITEM Ureu/ Krea#!!
NILAI 1=%6% ;610
ITEM SGOT SGPT B!*!ru-! T#a* B!*!ru-! D!re7#
NILAI 20 1% 06= 060%
ITEM $*r B*' B!*!ru-! Ur-!*!,e Ke# Pr#e! G*u3a 4H
NILAI Ku!, Mu'a 95 Ne,a#!? 9N 95 95 500 ;60
7. K#3#) G#%')*
NO 1( 2( 5. K#3#) H)!#
NO 1( 2( =( &( 8. U(#% R!#%
NO 1( 2( =( &( 5( ;( <( %(
RESUME :
Pa3!e 'a#a, e ru/a. 3a!# 'e,a e*u.a /u#a.9/u#a. +a, '!a*a/! 3e>a 1 /!,,u 3e-e*u/ /a3u ru/a. 3a!#( Mu#a. '!3er#a! ra3a /ua*6 ?reue3! 192 a*! 'a*a/ 3e.ar!( Mu#a.9/u#a. '!ra3aa /e/-era# .ar! !!6 /u#a. @10 a*!6 #!a4 a*! /aa 'a /!u/( R!"a+a# /e,3u/3! >a/u9>a/ua area +er!
<
4a'a *u#u# 'a ra3a ra/ 4a'a #u,a!( R!"a+a# /!u/ a#a3!'a 3aa# 4a3!e /u#a.9/u#a. 'a*a/ 3e/!,,u #e#a4! #!'a a'a 4eru-a.a( N+er! u*u .a#! #!'a a'a6 ra3a #er-aar '! 'aera. 'a'a #!'a a'a6 ra3a #!'a +a/a 4a'a 4eru# -a,!a a#a3 '!e*u.a 4a3!e( Mu#a. !3! /aaa6 #!'a a'a 'ara.( R!"a+a# /aa, #!'a a'a( Bua, a!r e7!* e3a -erura,( Bua, a!r -e3ar -!a3a6 7*a#( R!"a+a# -ua, a!r -e3ar .!#a/ '!3a,a*( De/a/ #!'a a'a6 r!"a+a# 'e/a/ '!3a,a*( Sa!# e4a*a a'a6 a3u4a /aaa /euru( Ba#u 'a 3e3a #!'a a'a( R!"a+a# Pe+a!# Se-e*u/+a
−
R!"a+a# D!a-e#e3 /e**!#u3 a'a 3e>a 1 #a.u *a*u6 GDS -!a3a+a 200 /,'* /!u/ /e#?r/! 500 /, 21 'a ,*!/e4!r!' 2 /, 11 'a '!/!u/ #!'a #era#ur(
−
R!"a+a# H!4er#e3! a'a 3e>a 1 #a.u +a, *a*u6 -!a3a+a 1&0:0 //., /!u/ a/*'!4!e 5 /, 116 '!/!u/ #!'a #era#ur(
−
R!"a+a# 4e+a!# >a#u, '!3a,a*
−
R!"a+a# #rau/a e4a*a '!3a,a*
−
R!"a+a# Pe+a!# 'a*a/ e*uar,a R!"a+a# 'a*a/ e*uar,a /e/!*!! '!a-e#e3 /e**!#u3 #!'a a'a( R!"a+a# Ga+a H!'u46 Mer 96 A*.* 9
Pe/er!3aa F!3! S#a#u3 Pre3e# Sa!# Se'a, G!z! $uu4 $/43 Me#!3 Ta'a9#a'a !#a* Teaa Dara. 1;0100 //H, Na'!
:2 a*! /e!#
Pera4a3a
20 a*! /e!#
Su.u
=;6
Ke4a*a Ae/!3 96 I#eru3 9 Le.er DVS R0 7/H2O Paru
Bu+! 4era4a3a Ve3!u*er R.! 996 ).eez!, 99
Ja#u, BJ III /ur! re,u*er6 Mur/ur 9 A-'/e Per!3#a*#! e3a r/a*6 He4ar 'a L!e T!'a #era-a %
E3#re/!#a3 T!'a a'a e*a!a
ASSESSMENT :
1( A7u#e K!'e+ I>ur+ e7 'e.!'ra3! DD A7u#e O $KD DD $KD Gra'e 5 2( D!a-e#e3 Me**!#u3 T!4e II N O-e3e =( H!4er#e3! ,ra'e 2 &( Ga3#r4a#! O-a# 5( Leu3!#3!3 Pr Ea*ua3!
PLANNING :
Re7aa Tera4!
− D!e# DM 1<00 a*.ar! − IVFD Na$* 06: 2% #4/ − Ne4.r3#er!* 250 772& >a/'r!43 − Me#?r/! 500 /,12 >a/ ra* TUNDA − G*!/e4!r!' 2/,2& >a/ra*(TUNDA − A/*'!4!e 10 /,2& >a/ ra* − O'a3e#r % /,%>a/!#raea − O/e4raz*e &0 /,12 >a/ !#raea
Re7aa T!'aa
− Pe/a3a,a Ka#e#er(
Re7aa '!a,3#! 9
$e H-A1$6 GDP6 GD2PP(
9
USG A-'/e
9
EKG
9
F# T.ra
9
Ba*a7e $a!ra
:
PROGNOSIS :
A' Fu7#!a/ Du-!a a' Ma*a/ A' Saa#!a/ Du-!a a# -a/ A' V!#a/
Du-!a
FOLLOW UP :
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500
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20
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21
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22
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