GAGAL GINJAL AKUT

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Hello!
I am Jayden Smith
I am here because I love to give
presentations. You can find me at
@username

3
1.
Transition headline
Let’s start with the first set of slides

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“ ▪ Penurunan fungsi ginjal
yang mendadak dengan
akibat hilangnya
kemampuan ginjal untuk
mempertahankan
homeostasis tubuh. Akibat
penurunan fungsi ginjal
terjadi peningkatan
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This is a
slide title

▪ Here you have a list of items

▪ And some text
▪ But remember not to overload your slides with
content

Your audience will listen to you or read the content, but

won’t do both.

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 • Hipovolemia
PRARENAL • Penurunan volume vaskular efektif
• Penurunan CO

• Kelainan vaskular intrarenal

• GN
RENAL • Nefritis interstisial
• ATN

• Kelainan kongenital
POSTRENAL • Didapat: batu, bekuan darah
• Tumor

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PEMERIKSAAN
PENUNJANG

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Urinalisis

▪ Volume
▪ Warna
▫ Merah kecoklatan  GN
▫ Merah muda  Hburia/mioglobinuria
▪ BJ
▫ >1.020  prarenal
▪ Proteinuria
▪ Hematuria
▪ Silinder hialin atau granular halus  prarenal
▪ Silinder granular kasar atau silinder eritrosit  GN
▪ Silinder sel tubulus  ATN 9
Indeks urin

▪ GGA prarenal  BJ tinggi (> 1.020) dan osmolalitas tinggi {>400

mOsm/kg)
▪ GGA renal  BJ urin rendah < 1.020, osmolalitas urin rendah <
400 mOsm/kg
▪ osmolalitas urin / serum yaitu pada GGA pra- renal >1,1 dan GGA
renal <1,1.
▪ Kadar Na GGK renal >40 mEq/L GGA prarenal rendah yaitu <20
mEq/L.

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FENa

▪ <1%  prarenal
▪ >2%  renal

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▪ Indeks gagal ginjal (IGG): (UNA : UKR / PKR x 100).
▫ GGA prarenal IGG - <1,0
▫ GGA renal IGG biasanya >3
▪ rasio ureum / kreatinin (GGA prarenal) >20 : 1 (Normal 20 : 1)
▪ U/P ureum (pada GGA prarenal >20, GGA renal < 3)
▪ U/P kreatinin (pada GGA prarenal > 40, GGA renal <20).

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RADIOLOGIS

▪ 1. Menentukan apakah kedua ginjal memang ada

▪ 2. Menentukan besarya ginjal
▪ 3. Menyingkirkan adanya obstruksi pada saluran
kemih
▪ 4. Melihat apakah aliran darah ginjal cukup adekuat.

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USG

▪ USG
▪ Scan radionuklir dengan Te99 DTPA.
▪ Ro toraks  pembesaran jantung dan edema paru  tanda
kelebihan cairan

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Biopsi Ginjal

▪ Bila dicurigai adanya GN progresif cepat atau nefritis interstisial.

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TATALAKSANA GGA

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GGA Pascarenal

▪ GGA pascarenal disingkirkan bedasarkan riwayat penyakit dan

pemeriksaan USG ginjal. Dilatasi pelvokalises sudah dapat dilihat
pada USG 24-36jam setelah terjadi obstruksi. Bila hal ini
ditemukan lokalisasi obstruksi perlu ditentukan kadang-kadang
memerlukan pemeriksaan pielografi antegrad atau retrograd.
▪ Katup uretra posterior  kateter VU
▪ Obstruksi diatas VU bilateral  nefrostomi segera

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GGA prarenal

▪ Sesuai etiologi
▫ GE dehidrasi RL atau DG
▫ Shock hemoragik  transfusi darah.
▫ Syok hipovolemia infus albumin atau plasma.
▫ Dehidrasi tidak jelas penyebabnya  RL 20 ml/kgBB dalam 1
jam. Biasaya diuresis terjadi setelah 2-4 jam pemberian cairan
rehidrasi.

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Diuresis paksa dan challenge cairan

▪ GGA atau ATN  diuretika, cara diuresis paksa,

▪ Prasyarat untuk tindakan ini: pasien telah tidak dehidrasi lagi dan
obstruksi saluran kemih (GGA pascarenal) sudah disingkirkan.

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▪ Mannitol 20% 0,5 gr (=21/2 ml)/kgBB di infus dalam 10-20 menit
▪ Furosemid 1 mg/kgBB, dinaikkan berganda setiap 6-8 jam sampai
10 mg/kgBB
▪ Mannitol, lebih berbahaya, maks 1x karena bersifat osmotik.
Berhasil bila diuresis naik 6-10ml/kgBB/jam dalam 1-2 jam.
▪ Pemberian diuretik dapat dilanjutkan meskipun sudah terbukti
GGA bersifat renal dengan tujuan merubah GGA oligurik menjadi
non oligurik untuk memudahkan pengaturan pemberian cairan
dan kalori. Selain diuretika dapat juga diberikan dopamin dosis
rendah yaitu 5 mikro/kgBB/menit untuk meningkatkan peredaran
darah ginjal. 22
Gagal Ginjal Renal

▪ Tujuan pengobatan: mempertahankan homeostasis

▪ Pemantauan:
▫ Tanda-tanda vital : TD, HR, RR, T
▫ Pemeriksaan darah : Hb, Ht, trombosit
▫ Darah ureum dan kreatinin
▫ Elektrolit : K, Na, Cl, Ca, P dan asam urat
▫ Analisis gas darah
▫ Protein total dan albumin
▫ Pengukuran diuresis berkala

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Terapi Konservatif

▪ Terapi cairan dan elektrolit

▫ IWL + jumlah urin 1 hari sebelumnya + cairan yang keluar,
dikoreksi dengan kenaikan suhu tubuh setiap 1oC sebanyak 12%.
▫ Perhitungan IWL  caloric expenditure
▸ 0-10 kg = 100 kal/kgBB/hari
▸ 11-20 kg = 1000 kal + 50 kal/kgBB/hari diatas 10 kgBB
▸ >20 kg = 1500 kal + 20 kal/kgBB/hari diatas 20 kgBB
▸ Jumlah IWL = 25 ml per 100 kal
▪ Neonatus = 50 ml/kgBB/hari
▪ Bayi < 1 tahun = 40 ml/kgBB/hari
▪ Anak < 5 tahun = 30 ml/kgBB/hari 24
▪ Anuria  glukosa 10-20%
▪ Oliguria  glukosa (10%)-NaCl = 3 : 1
▪ Jumlah kalori minimal untuk mencegah katabolisme: 400 kal/m2/hari
▪ Terapi konservatif > 3 hari  pertimbangkan pemberian emulsi
lemak dan protein 0,5 g/kgBB/hari, pemberian protein kemudian
dinaikkan sesuai dengan jumlag diuresis.

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▪ Asidosis metabolik
▫ Natrium bikarbonat
▸ BE x BB x 0,3 (mEq).
atau
▸ 2-4 mEq/kgBB/hari /12 jam.

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▪ Hiperkalemia
▫ K+ 5,5-7,0 mEq/l
▸ Kayexalat (kation exchange resin 1
mg/kgBB PO / per rektal 4 x 1
▸ Kalitake 3 x 2,5 gram

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28
Use charts to
explain your ideas

White Gray Black

29
BIG
Bring the attention of your

CONCEPT
audience over a key concept
using icons or illustrations

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You can also split
your content
White
Is the color of milk and fresh
snow, the color produced by
the combination of all the
colors of the visible spectrum.
Black
Is the color of coal, ebony,
and of outer space. It is the
darkest color, the result of the
absence of or complete
absorption of light.
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In two or three
columns
Yellow
Is the color of gold, butter
and ripe lemons. In the
spectrum of visible light,
yellow is found between
green and orange.
Blue
Is the colour of the clear
sky and the deep sea. It is
located between violet
and green on the optical
spectrum.
Red
Is the color of blood, and
because of this it has
historically been
associated with sacrifice,
danger and courage.
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 A picture is worth
a thousand words

A complex idea can

be conveyed with just
a single still image,
namely making it
possible to absorb
large amounts of data
quickly.

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Want
big
impact?

Use big
image.
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Use charts to
explain your ideas

White Gray Black

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 Or use Example text.
Example text. Example text.

diagrams to Example text. Example text.

Example text.
Business
explain
complex ideas Rise Risk

Leader Economy

Idea Profit

Example text. Finance

Example text.
Example text. Example text.
Diagram featured by Example text.
poweredtemplate.com Example text.

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And tables to
compare data

A B C

Yellow
10 20 7
Blue
30 15 10
Orange
5 24 16

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Maps

our
office

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89,526,124
Whoa! That’s a big number, aren’t you proud?

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89,526,124$
That’s a lot of money

185,244 users
And a lot of users

100%
Total success!
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Our process
is easy

first second last

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Let’s review
some concepts
Yellow
Is the color of gold, butter
and ripe lemons. In the
spectrum of visible light,
yellow is found between
green and orange.
Yellow
Is the color of gold, butter
and ripe lemons. In the
spectrum of visible light,
yellow is found between
green and orange.
Blue
Is the colour of the clear
sky and the deep sea. It is
located between violet and
green on the optical
spectrum.
Blue
Is the colour of the clear
sky and the deep sea. It is
located between violet and
green on the optical
spectrum.
Red
Is the color of blood, and
because of this it has
historically been
associated with sacrifice,
danger and courage.
Red
Is the color of blood, and
because of this it has
historically been
associated with sacrifice,
danger and courage.
42
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Thanks
Any questions?
!!
You can find me at @username &
user@mail.me

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Credits

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▪ Photographs by Unsplash

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