Sindroma (Ginjal)

Question 1

Sindroma (Ginjal)

Answer 1

Gangguan BAK/edema + gangguan fx ginjal (-) Ur/Cr normal

Question 2

Sindroma (Ginjal) (2)

Answer 2

Sindroma Nefrotik
Sindroma Nefritik

Question 3

Sindroma Nefrotik

Answer 3

💡
nefrOtik → Obesitas = gendut
Oedema
hiperlipidemia
Oval fat bodies

Question 4

Dx Sindroma Nefrotik

Answer 4

Edema anasarka
Hipoalbuminemia <3,5 g
Proteinuria masif +3, +4
Hiperlipidemia/hiperkolestrolemia

Question 5

Etio Sindroma Nefrotik

Answer 5

• Anak
  Minimal change disease
• Dewasa
  Nefropati DM

Question 6

PP Awal Sindroma Nefrotik

Answer 6

Urinalisa → proteinuria masif, oval fat bodies

Question 7

PP Tepat Sindroma Nefrotik

Answer 7

1. Biopsi → minimal change → sel podosit (-) (Gold Standard)
2. Uji esbach/protein 24 jam

Question 8

Tx Non Farmakologi Sindroma Nefrotik

Answer 8

Diet rendah garam
Normal protein 1-1,2 g/kgBB/hari

Question 9

Tx Farmakologi Sindroma Nefrotik

Answer 9

KS: Prednison

• Tahap 1
  Prednison 2 mg/kgBB/hari atau 60 mg/m2/hari → setiap hari (4 minggu)
• Tahap 2
  Prednison 1,5 mg/kgBB/hari atau 40 mg/m2/hari → setiap hari (4 minggu)

Question 10

Istilah Pengobatan Sindroma Nefrotik

Answer 10

Remisi
Relaps Jarang, Sering
Sensitive Steroid
Dependent Steroid
Resisten Steroid

Question 11

Sindroma Nefrotik: Remisi

Answer 11

= Sembuh

Proteinuria (-) 3 hari berturut

Question 12

Sindroma Nefrotik: Relaps

Answer 12

= Kambuh

Proteinuria (+) 3 hari berturut

💡 Rumus 2/6

• Jarang
  <2x/6 bulan
• Sering
  ≥2x/6 bulan

Question 13

Sindroma Nefrotik: Sensitive Steroid

Answer 13

Remisi setelah tahap 1

Question 14

Sindroma Nefrotik: Dependent Steroid

Answer 14

Relaps kembali setelah tahap 2 selesai
ATAU
Relaps jika steroid dihentikan

Question 15

Sindroma Nefrotik: Resisten Steroid

Answer 15

Remisi (-) setelah tahap 1

Tx: Imunosupresan → siklosforin, siklofosfamid, azatioprin

Question 16

Dx Sindroma Nefritik

Answer 16

Gross hematuria (eritrosit >5/LPB) → BAK darah tanpa mikroskop → cucian daging, cola, teh
Edema minimal (+/-)
Proteinuria minimal (+/-)
Hipertensi (+/-)
Oliguria (+/-)

Question 17

Etio Sindroma Nefritik

Answer 17

Streptococcus B-hemolyticus grup A → RPD: ISPA (1-2 mgg)/korengan, pioderma (3 mgg) → GNAPS

IgA nefropati (Berger’s disease), autoimun → SLE (lupus nefritik)

Question 18

PP Awal Sindroma Nefritik

Answer 18

Urinalisa → hematuria

Question 19

PP Tepat Sindroma Nefritik

Answer 19

• Etio: GNAPS (tersering)
  ASTO (+)
  C3 komplemen ↓
  GNAPS-deposit/kompleks Ag-Ab di tubulus
  Kultur swab tenggorokan
  Anti-DNaseB
• Etio: Lupus
  ANA test/antiDsDNA
• Etio: Berger’s disease
  Biopsi IgA(+)

Question 20

Tx Non Farmakologi Sindroma Nefritik

Answer 20

Diet rendah garam 0,5-1 g/hari
Diet rendah protein 0,6-0,8 g/kgBB/hari

Question 21

Tx Farmakologi Sindroma Nefritik

Answer 21

AB: GNAPS
1. ~~Inj. penisilin 1,5 juta/6 jam~~ Amoksisilin 50 mg/kgBB/hari dibagi 3 dosis selama 10 hari
2. ~~Eritromisin 3x500 mg~~ Eritromisin 30 mg/kgBB/hari dibagi 3 dosis selama 10 hari

Hipertensi sedang-berat: GNAPS
1. Captopril 0,3-2 mg/kgBB/hari
2. Furosemid
3. Kombinasi Captopril dan Furosemid