PPK CKD Ada Tabel

PANDUAN PRAKTIK KLINIS (PPK) TATA LAKSANA KASUS RSUDKOTA BEKASI JAWA BARAT 2013 – 2015

CHRONIK KIDNEY DISEASE

1. Penge ngert!n (De" e"n# n#)

Pen$!% !%t gn&!' %rn% n% !!'!* #+!t+ ,r#e# ,!t"#'g# eng!n eng!n et' et'g g $!ng -er!g! -er!g!/ / eng!% eng!%-!t -!t%!n %!n ,en+r+ ,en+r+n!n n!n "+ng# gn&!' $!ng ,rgre#"/ $!ng ter&! !'! !%t+  3  -+'!n !n ,!! !%*rn$! -er!%*r eng!n g!g!' gn&!'. 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+ er!&!t $!ng eer'+%!n ter!, ,engg!nt!n gn&!' $!ng tet!, -er+,! !'$## !t!+ tr!n#,'!nt!# gn&!'.

De"n# KD en+r+t NK4K6DO7I !!'!*8 1. Ker+#!%!n Ker+#!%!n gn&!' gn&!' #e'!! #e'!!  3 -+'!n 9!ng 9!ng !%# !%#+ + ter!,! ter!,!tt %er+#! %er+#!%!n %!n gn&!' gn&!' !!'!* !!'!* -'! -'! &+,! %e'!n!n #tr+%t+r !t!+ "+ng# gn&!' eng!n !t!+ t!n,! ,en+r+n!n :4R/ eng!n en g!n #!'!* #!t+ !n"e#t!#8

-

Ke'!n!n ,!t'g

-

Pet! Pet!n n!!

%er+ %er+#! #!%! %!n n

gn& gn&!' !'//

ter ter!# !#+% +%

%e'! %e'!n n!n !n

%,## !r!* !t!+ +rne/ !t!+ %e'!n!n r!'g. 2. :4R :4R ; <0 '6e '6en6 n61/ 1/=3 =32   3 -+'!n eng!n !t!+ t!n,! %er+#!%!n gn&!'.

2. An!ne##

1. Ke'+*!n ,!! KD 8 'e!*/ 'et!rg/ !nre%#!/ +!' +nt!*/ n%t+r!/ g!t!'/ #!%t %e,!'!/ g!ngg+!n t+r/ #e#!% n!"!#/ n$er !!/ "!tg+e/ ,!n!ng!n %!-+r/ 25

#"+ng# ere%#/ *,erten#/ ,er!r!*!n/ %e&!ng/ n$er 3. Peer%#!!n 4#%

#en/ t+'!ng !n "r!%t+r/ g!ngg+!n ent!'. 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.

@. Krter! D!gn##

. K+'t 8 %erng/ -er##%/ #>r!t>* !r%/ urea frost  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!+

5. D!gn## Ker&! <. D!gn## B!nng =. Peer%#!!n Pen+n&!ng

t!n,! %er+#!%!n gn&!'. KD (Chronik Kidney Disease) 1. AKI ( Acute Kidney Injury) 2. Snr! Ne"rt%  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 2<

3. Pe'gr!" !ntergr! 6 retrgr! @. US: 5. Rengr! C. Ter!,

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

2=

•

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!, 2C

"!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

Pe-!t!#!n

!,!t

en&!g!

%e#e-!ng!n

>!r!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'+%#!
•

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"tr!n/

>e"!'#,rn !n

gener!#

>e",er!Gn/

%e

$!ng

3/

#e,ert

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%!#. . E+%!#

1.

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

(Hospital Health ro!otion) 2.

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

3.

Kn#+'t!# :G.

@.

?"%!# g!$! *+, 8 -er*ent er%%/ %+r!ng !#+,!n ,rten/ 'e!% !n g!r!. O'!* r!g! ter!t+r.

5.

Kntr' ter!t+r/ ter+t!! %ntr' te%!n!n !r!* !n g+'! !r!* !n L4:. 30

10. Prgn##

A t!

8 +-! ! -n!6!'!

A #!n!tn! 8 +-! ! -n!6!'! 11. Tng%!t Een# 12. Tng%!t Re%en!# 13. Pene'!!* Krt#

1@. In%!tr ?e#

A "+ng#n! 8 +-! ! -n!6!'! I  1. Dr. Ett$ St An!*/ S,PD 2.

Dr. W!'+$ D !*$n/ S,PD

3.

Dr. J+'+# S!-!n/ S,PD

@.

Dr. 4e% ?. St*!ng/ S,PD

5.

Dr. :ere A!renr!/ S,PD

<.

Dr. E'G! 4e-r!#!r/ S,PD

=. Dr. R!*! S!"tr ?e+t!/ S,PD    .. 

15. Ke,+#t!%!!n

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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.

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