PFEBrB.

EKarina
dr
E#EgMgBrEZgg
.
Dwi

Eng
Neige
 Hipertensi
↳ SKDI kompetensi 4

I .
DEFENISI
↳ 9 TD 3140190 MmHg

I .
ETIOLOGI

PRIMER/ : -

idiopathic C lpeny
- .

essensial penyerta
genetic
-

SEKUNDER i
-

CKD

Ct)
d
perry .
penyerta
-

pheochromasitoma ¥
- tumor adrenal
-

hipertirotd → M HR 1
NE E
I KCASIFIKASI ,

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

is:÷÷f÷÷ IF.im#nissi
'
ers:S , .

7160/100
140/100
I 2 1601100 I'
11 3 180/110 III

isolated hlpertension → hanga sista yg naik !

( 3140 / go
<

diastiol
Langa
<
140 I > go
 ES : batch ( A bradikin )
I TERAPI HIPERTENSI f.

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

Isn
Kombinasi bkfanideaffn
Receptor Blocker CARB) -
o Cnsartan ) -

Ifa Blocker → ( uzosin ) b

-

prazosin . doxazos.in tamsulosin -

( 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

DHP → .

ECB
ES
t
: edema
f. Non DHP verapamil diltiazem
→ ,

hidrochlorohazid CHCT ) → hipokalemi hiponatremi

Diuretic
→ .

→ loop diuretic ( furosemide ) hipokalemi hiponatremi → .

I
Lrototoksik
Es :
gg - elektro lit b
-

spironolactone ( diuretic hematkalium )

MAV Ikot
La hiperkalemi

Tekanan Darrah
-
viskositasdarah
petrie
darah
← 1- volume
- diameter pemdarah
Cardiac Output Cco) race raskucar Resistance

f f CCB
volume ← Heart Rate L
sekuncvp stroke volume r -

Blocker
B blocker ACE E
/
- -

ARB
ee

pre toad
diuretic
 B .
( JanTung) ITD

bronkospasm
( sat nap as )
blok reseptor B
-

\
B blocker →

B' ( jaringanadiposa)

asmathipertensi → B, z Bz a B

http brtonko spasm

makin bera

dsrna t
hipertensi → B '

,
ITD
 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 ?
Usia Goth / DM / PG K
* <
← ↳
L. L 1401go 360 260

t t
Usia z, both a DMC ) / PG K G)
-

Lr a 150/90
<
15%0 44%0

1k , to th .
\

D M CA TD no
180/90 →
Target c
140 Igo
 ftp.eiatensi
I
v

Peruana gayahidup

✓
I
TD 3140/90

- Wyatt
penyatithpengerta-0 penyerta

✓ I sestuaika dgnpenyakio
Ht Stg I Ht Stg I
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)
I
-

LVH :
ACE I
-

( ARB f) edema
-

Atrial frontage :
B blocker

\ C$¥I
-

Ibu tanto : need crine ,

metirdopa
BPH
I powder
-

: -
I

A A- CEI →
agenesis
renal
selektie nonselektip
( pemdarah) ( pem -

draff salkencing)
a

t.am#/osin prazosin
Hi per ten si t DM
d
A- CEI → batch
t
A RB

g) ut arthritis
t
P AV
 200/100
HIPERTENSI KRIS IS
2b atau
l S t s
MAP :

T ↳ →

130×251 MMH8/>
TD 7180 D

=
2O0t) =

400g = : 30M Hg 120 mmHg

Hipertensi Urgensi thperqonsi Emergensi

)
↳ Sawai ↳ dare rot
④
todgatnaodetamage
①

Target t TD IMAP 25% + Map 2506

dalam 240am dalam 22am I jam
-

fatal aksana
-

oral
parenteral IN
captoprk SL
perdipine Needlpirie
. ,

dilliazem in icardi pin,①

END TARGET ORGAN DAMAGE jantung ← nifrogliserin I ISDN 1 nitro preside

tkesadarcn
stroke → nyeri kepala ,
,

Keyong ↳ muntdppoyekho
b Mata Kasur
Retinopathy
-

perdarahan Retina

nyeri dada

ftp.C#EEBr
myocardinfatk →

pea's:
:* eras .

Paro → edema → ronkhibasah

basal

Isa !
"

anuria , oliguria ,
th Ur , Cr

keening . mud ,

Mdneah
 00

Target organ
Amu ntahproyektiy
lxejang

of

diagnosis

e
( ×
x
fan
GJA ironkidisehirvh paro
→

→ kardiomegalicronki hipertensi
,

Hipertensi emergensi
×
X
x
 ABB
IS k p d OT : Proteus mirabilis

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

Pada kateter
Proteus sp → batu Strutt

A- egala Kunis i DEMAM ! !

- pyelonephritis
- demon
-

Nyeri ping gang

'
-

Maal Muntari
-

Pf : Nyeri ketok
CHAItapping
pain ,

50 -

80£ Ti freku
end drank
,
,

-
C-
Idema cystitisheortaoy
←
I
BAK)
-

disuriacnyeri
TY BA anyang 2am
-

④ uretrlhr BAK Adak lompiao

-

pf
-

:
Nyeri teton
J piura suprapubik
-

prostatitis
-
Ckenangnanah )
DRE : nyeri pd prostate
A
GO Non GO
L
N -

gonorrhea C. trachoma tis

 PEM .
PENUNJANG

Urinalisa -
D leukosituria ( leukosit 751406 ) . bakteri ⑦
,
d nlrit
awal Marit ⑦ -
b nitrate -
b
T
①
Kultur URIs →
GOLD STANDARD
109¥
-

d
> 103 -
→ simptomatik
tepat aslmptomatik
3105 →

mid
Pengambilan Sampsel win → stream (urine paneer tengah Iposisi tengah
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

Non komplikata : semva ISK pd wanita ISK

pd anak
C- I hamil 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
 TMP sulifamefoxazole
r
2nd Cofrimoxazole 2×960 f 7:
-
to her

Pyelonephritis : 1st line : Gol Qiunolon 18 :

lo -
14 her

t ciprofloxacin 2×500 My
}
-

Khari
↳ pd 7 -

:
berate
HD
PN berat to Rawat Thap
-

ggn mvntah
Maal , -
↳ aol.ceeacospop.in µ ②

hqniwanak
-

- ↳ Gol Quinol on IV-

①

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

Anak kotrimoxazole 10mg 1kg BB Hari

'

Cdioagi 2 dosir )

Batu Saluran Kemih r

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

-
ISK non
komplikata : *
Nitrofurantoin 2.
xioomg
t *
cotrimoxaeeole 2×960 ng
3- 5 hari * Quinolone

• ISK
komplikata : Quinolone
I Cofrimoxazole
7- 14
hari
→
komplikata

x
× Yskkomplikata
x

lskkomptikata
sistitis

t
pieloneeritis
 Demain G)
- nefpeolltiasisr
-

nyeri pinggang ,

Meng alar keperut

i
nyeri menjalarke -

PF :
nyeri ketok OVA
perutbawah e-
prox Jlkahidroneerosir
,
• =
↳ ballot@Ment

-
Urcoterohtiasis
nyeri menjalarke- med f -

Nyeri pinggang ,

selangkangan -

Holik menoalarhingga ke
renal selangkangon Isoform
nyenmenjalar # dis -

PF :
Nyeri

¥
ketone CVA
Skrotum ( labia
- vesikolltiasir

Boff
• -

BAK

berubah
berhenti ,

posisi
sika
BAK

5mg .at?scar-kem6aii-otidakbisaBAk,nyeRihe6at
ffuretroiin
•

↳ menarik '
penis

PEMERIKSAAN PENUNDANG

Awal : urination b
-
hematuria to orthosis 75 llpb
- -
Kristal ⑦
Fotopdos
[any Utah BNO ( abdomen

B.NO/wp!RadioopaqRadiolusen,kontraindikaripdCr3k5
:

9
I

USG Ginga :
acoustic Shadow
CT Scan : GOLD STANDARD
t
Non contract ( NCCT )
SEAMEN URIN

JARUM to atom urat

stagnhorn
I

Prisma ( pet Mari

0
→
triple fosfat

→ 9h01 Rack
Cr > 115
x dupokai
b
-

←
 → asam

batu basa batu asam

TATALAKSANA
y →
1 .
NON FARMAKOLOGIS : konservatif :
hidrasi ,
bionat

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

Ukuran Batu

E5 mm

konservatif
\ -
320mm

pembedahan
6
5- gmm
10 lgmm
CPCNL)
-

ESWL URS
 1
horn
stag

→ asam u rat → bic nat

 onkotik
i. an

n re n rn
N

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 ↳ protein
-
Riw korengan
Thad 7200 To 7150 eisbach
↳ ,
-

e proteinuria (edema perioribita

ETIOLOGI i idopatik
→
PRIMER :
pd anak SS ) -
G- NAPS -
D Streptococcus B. Hemoliticvr
(minimal change D ) ↳ realest Hypersensitivity tie HI I
Selander : nefropdti DM - LN is ANA ⑦ komplex
-
IgA here Ropati → biopsi Ag Ab
-

to (t )
berget disease
-

IgA

÷:÷÷÷:÷÷÷÷÷÷÷÷¥::÷
"

÷:÷: :*
-

...
Z

Kelantan minimal anak

)
→
( dewas 'd
glomenlosklerotik pokal segmental
TREATMENT N - t -
11291kgBB that
d garam I girl keep Ihr
dict t Garam
y
non Farma ko i
: 016 -
018
,

apart protein normal d protein ①"

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

FUROSEMIDE that alergi .

orllwmiswi 44500
-

ACE I -

( ARB . Ace I IARB (anti hipertensi)

-

↳ 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 HI
tahap I
•

↳ Thhlnosupresont :
Slklosporin ,
MME
 + infeksi
→
gross hematuria
IgA Nee ropati
LN ↳NAPS

gitndrom nefritik → GNApg

I
→ hip albumin
roti k
↳ proteinuria Nee

→ Sind rom nee roti k

↳ protein eisbaeh
 G-GOA vs
G6④
anuria ( oliguria → Uop N -
-
O 5 .
-
I a 1kgBB) gon
sedikie ) 30a loan
( BAK
Reversible

1
irreversible 720 CC

pgmarjah sepsis ,
CHF

ETIOLOGI :
pre renal -

bdehidrasi , prdrhn Perry Kronig (DM ,

HT )
Ceritropoietin)
.

def
Renal lskemiic ( ATN ) tubular anemia D EPO
acute necrosisKel Iain
b
-
: -
-
.

-
↳

post Renal
-
b obstruksi -
Maal Muntean hereat
-
-
t -
Koma uremlkim /
BSk
BPH ,
penurunanckesadaran 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

45 -5g
Failure :
> 3X
3 a
IT
,
60 -

89

> IT
anemia
Loss i
74 Minggo 30 -

59
b
-

End stage i 73 bulan ( CKD) 3b

i
15 -

29
overload
'

.su/bb16jam 30 44 ✓ L 15 →
Risk
- '

: UOP co

Injury UOP 0,54 Ibb Cr I

,/zj
-

:
-

<

Failure : UOP -7 anuria Shama 12J

I i 790
II . 60 - 89
59
'

30 -

th .

Iv . 15 -
2g -

V 215 -

i
-
 µ
TotalAksana AKI TATALAKSA NA CKD
-

RuyUk -

Anemia → EPO

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

IndiKasi HD Ato !
-

A i
Asidosis metabolite
(KU : sersaknaeas ,
Kuss Maul )

dsrhanjt Ttt
pH < 7,1

lntoksikasi

*
I i

( 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
 c-
0

renal
→ pre

tensefalopati
vremikum