Refrat Gagal Ginjal

7/23/2019 Refrat Gagal Ginjal

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REFERAT

DEMAM TIFOID

Oleh

Deny Rahmat Pamungkas (1102009072)

Yuke Put! (1102010"00)

Pem#!m#!ng

D$ %enny & &'esna *$PD

D$ en' M &am!l *$PD

D$ D!nny +$ P!ha,! *$PD M$kes

&EPA-ITERAA- &.I-I& /A+IA- I.M PE-YA&IT DA.AM

RMA% A&IT MM DAERA% OREA-+

201

1


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Daftar Isi

HALAMAN JUDUL . i

DAFTAR ISI .. ii

BAB I. PENDAHULUAN . 1

BAB II. TINJAUAN PUSTAKA 3

II. 1 Demam Tifoi .!

II.1 Defi"isi ...##

II.3.# Etio$o%i ....#3

II.3.3 Patofisio$o%i #&

II.3.' (e)a$a K$i"is#*

II.3.& Dia%"osis ...3+

II.3., Pe"ata$a-sa"aa" ..31

II.3.! Kom$i-asi.3'

II.3./ Pro%"osis 3&

II. ' (a%a$ (i")a$ Kro"i-

II.'.1 Defi"isi 3&

II.'.# K$asifi-asi..3,

II.'.3 Etio$o%i...3!

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II.'.' (e)a$a K$i"is..'+

II.'.& Dia%"osis'#

II.'., Pe"ata$a-sa"aa" '*

II.'.! Kom$i-asi &,

II.'./ Pro%"osis &,.

III. DAFTAR PUSTAKA &!

3


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/A/ I

PE-DA%.A-

Demam tifoi masi0 mera-a" e"2a-it e"emi- i I"o"esia. Pe"2a-it i"i

ma0 me"$ar a" aat me"2era"% a"2a- ora"% se0i"%%a aat me"im$-a"

4aa0. Se)a- a4a$ aa -e5#+6 i"sie"s emam tifoi me"r" i USA a" Eroa.

Ha$ i"i i-are"a-a" -eterseiaa" air ersi0 a" sistem ema"%"a" 2a"% ai-6 a"

i"i e$m imi$-i sea%ia" esar Ne%ara er-ema"%.

(i")a$ aa$a0 seasa"% or%a" ere"t- -a7a"% 2a"% ter$eta- i e$a-a"%

ro"%%a aome"6 sat i setia sisi 7o$m"a 8ertera$is sei-it i atas %aris i"%%a"%.

(i")a$ me"%o$a0 $asma 2a"% me"%a$ir mas- -e a$am"2a "t- me"%0asi$-a" ri"6

me"a0a" a0a"9a0a" terte"t a" me"%e$imi"asi a0a"9a0a" 2a"% tia-

ier$-a" -e a$am ri". Setia %i")a$ teriri ari se-itar sat )ta sata" f"%sio"a$

er-ra" mi-ros-oi- 2a"% i-e"a$ sea%ai "ero"6 2a"% isat-a" sat sama $ai"

o$e0 )ari"%a" i-at. Setia "efro" teriri ari -omo"e" 8as-$er a" -omo"e"

t$s6 2a"% -ea"2a se7ara str-tra$ a" f"%sio"a$ er-aita" erat.

Ba%ia" omi"a" aa -omo"e" 8as-$er aa$a0 %$omer$s6 sat er-as

-ai$er ere"t- o$a temat fi$trasi sea%ia" air a" :at ter$art ari ara0 2a"%

me$e4ati"2a. Sea"%-a" -omo"e" t$s ari setia "ero" aa$a0 sat sa$ra"

ero"%%a erisi 7aira" 2a"% tere"t- o$e0 sat $aisa" se$ eite$. ;aira" 2a"% sa0

terfi$trasi i %$omer$s6 2a"% -omosisi"2a "2aris ie"ti- e"%a" $asma6 -emia"

me"%a$ir -e -omo"e" t$s "efro"6 temat 7aira" terset imoifi-asi o$e0

era%ai sistem tra"sortasi 2a"% me"%a0"2a me")ai ri".

Di "e%ara ma)6 e"2a-it -ro"i- tia- me"$ar


5/40

%i")a$ -ro"i-6 sa0 me"%%a"ti-a" e"2a-it me"$ar (a%a$ (i")a$ Kro"i-


6/40

%i")a$ -ro"i- i I"o"esia sema-i" me"i"%-at. Jm$a0 e"erita %a%a$ %i")a$ i

I"o"esia se-itar 1&+ ri ora"% a" 2a"% me")a$a"i 0emoia$isis 1+ ri ora"%. Dari

ata i eeraa sat "efro$o%i i I"o"esia ier-ira-a" re8a$e"si e"2a-it %i")a$

-ro"i- masi"%5masi"% er-isar 1++ 5 1&+@ 1 )ta e"-. U"t- e"2a-it %i")a$

a-t6 ata re8a$e"si tia- aat i-eta0i e"%a" teat1.

Berasar-a" 0a$50a$ terset i atas6 ma-a e"$is merasa er$ mema0as

$ei0 $a")t me"%e"ai %a%a$ %i")a$ e"%a" 0araa" aat me")e$as-a" $ei0 $a")t

efi"isi6 a"atomi fisio$o%i6 -$asifi-asi6 atofisio$o%i6 ma"ifestasi -$i"is6 serta

e"ata$a-sa"aa" aa %a%a$ %i")a$ -ro"is ma" %a%a$ %i")a$ a-t.

/A/ II

TI-AA- PTA&A

II. 1 Demam Tifoi

II.1.1 Defi"isi

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II.1.# Etio$o%i

II.1.3 Patofisio$o%i

II.1.' (e)a$a K$i"is

Demam tifoi memi$i-i masa i"-asi a"tara 1+ samai 1' 0ari6 %e)a$a 2a"%

tim$ sa"%at er8ariasi ari ri"%a" samai erat. Paa mi"%% ertama6 item-a"

-e$0a" a" %e)a$a 2a"% sera e"%a" e"2a-it i"fe-si a-t 2ait emam6 "2eri

-ea$a6 si"%6 "2eri otot6 a"ore-sia6 ma$6 m"ta06 ostiasi ata iare6 erasaa"

tia- e"a- i ert6 at-6 a" eista-sis.

Paa emeri-saa" fisi- iaat-a" s0 aa" 2a"% me"i"%-at. Sifat

emam aa$a0 e"%a" tie emam 2a"%

II.3.& Dia%"osis ...3+

II.3., Pe"ata$a-sa"aa" ..31

II.3.! Kom$i-asi.3'

II.3./ Pro%"osis 3&

II$ 1 Demam T!3'!,

II$"$1 De3!n!s!

(a%a$ %i")a$ a-t aa$a0 si"rom 2a"% teriri ari e"r"a" -emama"

fi$trasi %i")a$


8/40

rere"a$ ta"a %a"%%a" re"a$


9/40

#. Pe"r"a" 7ra0 )a"t"% aa %a%a$ )a"t"% -o"%estif6 i"far- mio-arim6

tamo"ae )a"t"%6 a" emo$i ar.

3. asoi$atasi erifer ter)ai aa s2o- seti76 a"afi$a-sis a" 7eera6 a"

emeria" oat a"ti0ierte"si.

'. (a"%%a" aa em$0 ara0 %i")a$6 ter)ai aa roses emea0a"6

e"%%"aa" oat a"estesi6 oat e"%0amat rosta%$a"i"6 si"rom 0eato5

re"a$6 ostr-si em$0 ara0 %i")a$6 isea-a" -are"a aa"2a ste"osis

arteri %i")a$6emo$isme6 tromosis6 a" 8as-$itis.

&. Paa 4a"ita 0ami$ isea-a" o$e0 si"rom HELLP6 er$e"%-eta" $ase"ta

a" erara0a" sotartm 2a"% iasa"2a ter)ai aa trimester 3.

Pe"2ea %a%a$ %i")a$ aa re"a$

9


10/40

1$ smata" reter 2a"% ter)ai aa firosis ata tmor retroerito"ea$6 stri-tra

i$atera$ as7aoerasi ata raiasi6 at reter i$atera$6 "e-rosis ai$er

$atera$6 a" o$a )amr i$atera$.

2$ Smata" retra6 0iertrofi rostate e"i%"a6 -a"-er rostat6 stri-tra reter6

-a"-er -a""% -emi06 -a"-er ser8i-s6 a" -a""% -emi0 G"ero%e"i-.

Ta#el 1$ &las!3!kas! ++A menuut The A5ute D!alys!s 6ual!ty In!t!at!'ns +'u*

&!te!a la4u 3!ltas! gl'meulus &!te!a 4umlah u!ne

Ris-

I")r2Fai$re

Loss

ESRD

Pe"i"%-ata" serm -reati"i" 16& -a$i

Pe"i"%-ata" serm -reati"i" # -a$iPe"i"%-ata" serm -reati"i" 3 -a$i ata

-reati"i" 3&& mo$@$

(a%a$ %i")a$ a-t ersiste"6 -ersa-a" tota$

f"%si %i")a$ se$ama $ei0 ari ' mi"%%

(a%a$ %i")a$ termi"a$ $ei0 ari 3 $a"

+6& m$@-%@)am se$ama ,

)am

+6& m$@-%@)am se$ama 1#

)am

+6& m$@-%@)am se$ama #'

)am

ata a"ria se$ama 1# )am

II$"$" Pat'3!s!'lg!

U"it -er)a f"%sio"a$ %i")a$ iset sea%ai "efro". Setia "efro" teriri ari

-as$a Bo4ma" 2a"% me"%itari -ai$er %$omero$s6 t$s -o"torts ro-sima$6

$e"%-"% He"$e6 a" t$s -o"torts ista$ 2a"% me"%oso"%-a" iri -e -ts

e"%m$1.

Da$am -eaaa" "orma$ a$ira" ara0 %i")a$ a" $a) fi$trasi %$omero$s re$atif

-o"sta" 2a"% iatr o$e0 sat me-a"isme 2a"% iset otore%$asi. Da me-a"isme

2a"% erera" a$am atore%$asi i"i aa$a0 > Resetor re%a"%a" mio%e"i- a$am otot o$os 8as7$ar arterio$ afere"

Tima$ a$i- t$o%$omer$ar

10


11/40

Se$ai" it "orei"efri"6 a"%iote"si" II6 a" 0ormo" $ai" )%a aat

meme"%ar0i atore%$asi. Paa %a%a$ %i")a$ re5re"a$ 2a"% tama isea-a" o$e0

0ioerfsi %i")a$. Paa -eaaa" 0io8o$emi a-a" ter)ai e"r"a" te-a"a" ara06

2a"% a-a" me"%a-ti8asi aroresetor -ario8as-$ar 2a"% se$a")t"2a me"%a-tifasi

sistim saraf simatis6 sistim re""i"5a"%iote"si" serta mera"%sa"% e$easa"

8asoressi" a" e"ot0e$i"5I


12/40

Paa %a%a$ %i")a$ re"a$ ter)ai -e$ai"a" 8as-$ar 2a"% seri"% me"2ea-a"

"e-rosis t$ar a-t. Dima"a aa NTA ter)ai -e$ai"a" 8as7$ar a" t$ar Paa

-e$ai"a" 8as-$er ter)ai16#>

1= Pe"i"%-ata" ;a# sitoso$i- aa arterio$ affere"t %$omero$s 2a"%

me"2ea-a" se"sitifitas ter0aa ssta"si5ssta"si 8aso-o"stri-tor a"

%a"%%a" otore%$asi.

#= Ter)ai e"i"%-ata" stress o-siatif 2a"% me"2ea-a" -ersa-a" se$ e"ote$

8as-$ar %i")a$6 2a"% m"%a-iat-a" e"i"%-ata" A5II a" ET51 serta

e"r"a" rosta%$a"i" a" -eterseiaa" "itri7 oie 2a"% earasa$ ari

e"ote$ia$ N5si"tase.

3= Pe"i"%-ata" meiator i"f$amasi seerti tmor "e-rosis fa-tor a" i"ter$e-i"5

1/6 2a"% se$a")t"2a a-a" me"i"%-at-a" e-sresi ari i"trase$$er a0esio"

mo$e7$e51 a" P5se$e7ti" ari se$ e"ote$6 se0i"%%a e"i"%-ata" er$e-ata"

se$ raa"% tertama se$ "etrofi$. Keaaa" i"i a-a" me"2ea-a" e"i"%-ata"

rai-a$ eas o-si%e". Kes$r0a" roses i atas se7ara ersama5sama

me"2ea-a" 8aso-o"stri-si i"trare"a$ 2a"% a-a" me"2ea-a" e"r"a"

(FR.

12


13/40

(amar 1. Patofisio$o%i %a%a$ %i")a$ a-t i re"a$.

Paa -e$ai"a" t$ar ter)ai#>

1= Pe"i"%-ata" ;a#6 2a"% me"2ea-a" e"i"%-ata" 7a$ai" sitoso$i-

0os0o$iase A# serta -ersa-a" a7ti"6 2a"% a-a" me"2ea-a" -ersa-a"

sitos-e$eto". Keaaa" i"i a-a" me"%a-iat-a" e"r"a" aso$atera$Na@K5ATP ase 2a"% se$a")t"2a me"2ea-a" e"r"a" reasorsi

"atrim i t$s roima$is serta ter)ai e$easa" Na;$ -e ma7$ae"sa.

Ha$ terset me"%a-iat-a" e"i"%-ata" ma" t$o%$omer$er.

#= Pe"i"%-ata" N 2a"% erasa$ ari i"7i$e N s2"tase6 7asases a"

meta$$orotei"ase serta efisie"si 0eat s0o7- rotei" a-a" me"2ea-a"

"e-rosis a" aotosis se$.

3= str-si t$s6 mi-rofi$i t$s ro-sima$is 2a"% ter$eas ersama eris

se$$er a-a" meme"t- sstrat 2a"% me"2mat t$s6 a$am 0a$ i"i aa

t0i7- asse"i"% $im iro-si Tamm5Horsfa$$ rotei"


14/40

aa"2a "atrim 2a"% -o"se"trasi"2a me"i"%-at aa t$s ista$is. (e$

o$imeri- THP ersama se$ eite$ t$s 2a"% ter$eas ai- se$ 2a"% se0at6

"e-roti- ma" 2a"% aotoi-6 mi-rofi$i a" matri-s e-strase$$er seerti

firo"e-ti" a-a" meme"t- si$i"er5si$i"er 2a"% me"2ea-a" ostr-si

t$s %i")a$.

'= Kersa-a" se$ t$s me"2ea-a" -eo7ora" -ema$i ari 7aira"

i"trat$er mas- -e a$am sir-$asi erit$er. Kese$r0a" roses terset

i atas se7ara ersama5sama 2a"% a-a" me"2ea-a" e"r"a" (FR.

(a%a$ %i")a$ ost5re"a$6 ((A ost5re"a$ mera-a" 1+? ari -ese$r0a"

((A. ((A ost5re"a$ isea-a" o$e0 ostr-si i"tra5re"a$ a" e-strare"a$.

str-si i"trare"a$ ter)ai -are"a eosisi -rista$


15/40

(amar #. Bat aa %i")a$

II$"$ +e4ala &l!n!s

(e)a$a -$i"is 2a"% seri"% tim$ aa %a%a$ %i")a$ a-t aa$a0 )m$a0 8o$me

ri"e er-ra"% a$am e"t- o$i%ori i$a ro-si ri"e '+ m$@0ari6 a"ri i$a

ro-si ri" &+ m$@0ari6 )m$a0 ri"e 1+++ m$@0ari tetai -emama"

-o"se"trasi ter%a"%%6 a$am -eaaa" i"i iset 0i%0 ott re"a$ fai$re. (e)a$a

$ai" 2a"% tim$ aa$a0 remia ima"a BUN i atas '+ mmo$@$6 eema ar ter)ai

aa e"erita 2a"% me"aat terai 7aira"6 asiosis metao$i- e"%a" ma"ifestasi

ta-i"ea a" %e)a$a -$i"i- $ai" ter%a"t"% ari fa-tor e"2ea"2a#.

II$"$ D!agn's!s

Dia%"osis ite%a--a" "t- aat memea-a" ((A re5re"a$6 re"a$6 a"

ost5re"a$. Dia4a$i e"%a" me"a"2a-a" ri4a2at e"2a-it "t- me"%eta0i saat

m$ai"2a ((A serta fa-tor5fa-tor e"7ets 2a"% ter)ai6 ta"2a-a" $a ri4a2at

e"2a-it a0$. Pemeri-saa" fisi- 2a"% 0ars ier0ati-a" aa$a0 stats 8o$me

asie"6 emeri-saa" -ario8as-$er6 e$8is6 a" re7tm6 a" emasa"%a" -ateter

"t- memo"itor )m$a0 ri"e 2a"% -e$ar se$ama emeria" terai 7aira".

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16/40

Pemeri-saa" $aoratorim 0ars me"7a- e$e-tro$it serm6 BUN6 -reati"i" serm6

-a$sim6 fosfor6 a" asam rat#.

Pemeri-saa" e"")a"% $ai" 2a"% e"ti"% aa$a0 emeri-sa" US( %i")a$

"t- me"e"t-a" -ra" %i")a$ a" "t- me"%e"a$i at a" 0iro"efrosis6 i$a

er$ $a--a" ios2 %i")a$ see$m terai a-t i$a--a" aa asie" e"%a" ((A

2a"% etio$o%i"2a tia- i-eta0i. A"%io%rafi


17/40

Stats 8o$me asie" 0ars ite"t-a" a" iotima$-a" e"%a" ema"taa"

erat aa" asie" serta asa" a" -e$ara" 7aira" setia 0ari. Paa asie" e"%a"

-e$ei0a" 8o$me6 -eseima"%a" 7aira" aat ierta0a"-a" e"%a" me"%%"a-a"

ireti-a Frosemi samai e"%a" '++ m%@0ari. Dosis oat 0ars isesai-a"

e"%a" ti"%-at f"%si %i")a$6 oat5oat 2a"% me"%a""% ma%"esim ro-si ri"e &+ m$ i" 1# 0

3. Hier-a$emia > -aar otassim ,6& mmo$@L

'. Asiemia > H !6+

&. A:otemia > -aar rea 3+ mmo$@L

,. E"sefa$oati remi-m

!. Neroati@mioati remi-m

/. Peri-aritis remi-m

*. Natrim a"orma$itas $asma > Ko"se"trasi 1&& mmo$@L ata 1#+ mmo$@L

1+. Hiertermia

11. Kera7"a" oat

Ket0a" %i:i aa %a%a$ %i")a$ a-t

1. E"er%2 #+93+ -7a$@-%BC@

#. ;aro02rates 39&


18/40

'. Protei"


19/40

Ntrisi e"tera$ ata are"tera$6 )i-a

er)a$a"a" -$i"i- $ama ata -atao$i-

I"i-asi 0emoia$isa aa %a%a$ %i")a$ a-t#>

1. ((T < -$ire"s -reati"i" & m$@m=

#. ((A er-ea")a"%a" < & 0ari=

3. ((A %. > a. -eaaa" mm 2a"% r-

. K serm , mE@L

7. BUN #++ m%?

. H ara0 !61e. F$i o8er$oa

'. I"to-si-asi oat 2% %a%a$ % terai -o"ser8atif

II$"$7 &'m*l!kas!

Kom$i-asi metao$i- era -e$ei0a" 7aira"6 0ier-a$emia6 asiosis

metao$i-6 0io-a$semia6 serta e"i"%-ata" rem 2a"% $ei0 7eat aa -eaaa"

0ier-atao$i-. Paa o$i%ri- aat tim$ eema -a-i6 0ierte"si a" eema ar6

2a"% aat me"im$-a" -eaaa" %a4at. Hier-a$emia ter)ai -are"a eeraa 0a$

seerti e-s-resi me$a$i %i")a$ ter%a"%%6 eri"a0a" -a$im -e$ar se$6 -ersa-a"

se$ a-iat roses -atao$i-6 trama6 sesis6 i"fe-si6 ata aat )%a isea-a" -are"a

asa" -a$im 2a"% er$ei06 -eaaa" i"i era0a2a -are"a isa me"2ea-a" 0e"ti

)a"t"% a$am -eaaa" iasto$i-. Asiosis ter)ai -are"a i-aro"at ara0 me"r"

a-iat e-s-resi asam "o"8o$ati$e ter%a"%% ima"a )%a me"i"%-at-a" a"io" %a.

Hio-a$semia seri"% ter)ai aa a4a$ ((A a" aa fase e"2em0a" ((A.

Kom$i-asi sistemi- seerti1#>

1. Ja"t"%

Eema ar6 aritmia a" efsi eri7arim.

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20/40

#. (a"%%a" e$e-tro$it

Hier-a$emia6 0io"atremia6 a" asiosis

3. Nero$o%i>

Iiritai$itas "eroms-$ar6 tremor6 a" -oma6

'. (a"%%a" -esaara" a" -e)a"%.

&. (astroi"testi"a$>

Nasea6 m"ta06 %astritis6 a" $-s eti-m.

,. Perara0a" %astroi"testi"a$

!. Hemato$o%i

A"emia6 a" iastesis 0emora%i-

/. I"fe-si

P"emo"ia6 seti-emia6 a" i"fe-si "oso-omia$.

*. Hamata" e"2em0a" $-a

II$"$ P'gn's!s

Morta$itas a-iat ((A er%a"t"% -eaaa" -$i"i- a" era)at %a%a$ %i")a$.

Per$ ier0ati-a" fa-tor sia6 ma-i" ta ma-i" )e$e- ro%"osa"2a6 aa"2a i"fe-si

2a"% me"2ertai6 erara0a" %astroi"testi"a$6 e"2ea 2a"% erat a-a" memerr-

ro%"osa. Pe"2ea -ematia" terseri"% aa$a0 i"fe-si


21/40

2a"% ita"ai e"%a" e"r"a" f"%si %i")a$ 2a"% ire8ersie$6 aa sat era)at

2a"% memer$-a" terai e"%%a"ti %i")a$ 2a"% teta6 era ia$isis ata tra"s$a"tasi

%i")a$. Da" ita"ai e"%a" aa"2a remia < rete"si rea a" sama0 "itro%e" $ai""2a

a$am ara0=1#.

Kriteria Pe"2a-it (i")a$ Kro"i-3

1. Kersa-a" %i")a$ 2a"% ter)ai $ei0 ari 3 $a"6 era -e$ai"a" st-tra$

ata f"%sio"a$6 e"%a" ata ta"a e"r"a" $a) fitrasi %$omero$s


22/40

K$asifi-asi Pe"2a-it (i")a$ Kro"i- atas asar Dia%"osis Etio$o%i

Penyak!t T!*e may' (5'nt'h)

Pe"2a-it %i")a$ iaetes Diaetes tie 1 a" #

Pe"2a-it %i")a$ "o" iaetes Pe"2a-it %$omer$ar

a. Pe"2a-it are"-im %i")a$1=. Pe"2a-it %i")a$ rimer >!lomerulone*ritis+ "ielone*ritis6 e"2a-it %i")a$

o$i-isti-.

#=. Pe"2a-it %i")a$ se-"er >Ne*ritis$s6 ne*ro"ati6 0ierte"si6 iaetes

me$its. Pe"2a-it %i")a$ ostr-tif > Be"i%"a Prostate Hiertroi6 at sa$ra" -emi06

ref$-s reter.Se7ara %aris esar e"2ea %a%a$ %i")a$ aat i-ate%ori-a" me")ai>a. I"fe-si 2a"% er$a"% a" "efro" 2a"% memr-

. str-si sa$ra" -emi0

7. Destr-si em$0 ara0 a-iat iaetes a" 0ierte"si 2a"% $ama. S7ar aa )ari"%a" a" trama $a"%s"% aa %i")a$

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Ta#el klas!3!kas! se#a#


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Isti$a0 %$omer$o"efritis i%"a-a" "t- era%ai e"2a-it %i")a$ 2a"%

etio$o%i"2a tia- )e$as6 a-a" tetai se7ara mm memeri-a" %amara" 0istoato$o%i

terte"t aa %$omer$s. Berasar-a" smer ter)ai"2a -e$ai"a"6 %$omer$o"efritis

iea-a" rimer a" se-"er. ($omer$o"efritis rimer aai$a e"2a-it asar"2a

erasa$ ari %i")a$ se"iri sea"%-a" %$omer$o"efritis se-"er aai$a -e$ai"a"

%i")a$ ter)ai a-iat e"2a-it sistemi- $ai" seerti iaetes me$its6 $s eritematoss

sistemi-6 mie$oma m$tie$6 ata ami$oiosis.(amara" -$i"i- %$omer$o"efritis m"%-i" ta"a -e$0a" a" item-a"

se7ara -eet$a" ari emeri-saa" ri" rti" ata -e$0a" ri"%a" ata -eaaa" arrat

mei- 2a"% 0ars memer$-a" terai e"%%a"ti %i")a$ seerti ia$isis.. Diaetes me$its

Me"rtAmerican Diaetes Association


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me$a. Se$ai" o$e0 -are"a -e$ai"a" %e"eti-6 -ista aat isea-a" o$e0 era%ai

-eaaa" ata e"2a-it. Jai %i")a$ o$i-isti- mera-a" -e$ai"a" %e"eti- 2a"% a$i"%

seri"% iaat-a". Nama $ai" 2a"% $ei0 a0$ ia-ai aa$a0 e"2a-it %i")a$

o$i-isti- e4asa -e$ai"a" 0emooeisis6

sa$ra" 7er"a6 mata6 -$it6 se$at serosa6 -e$ai"a" "erosi-iatri a" -e$ai"a"

-ario8as-$ar>

a. Ke$ai"a" 0emooeisis

A"emia "ormo-rom "ormositer a" "ormositer


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0ier8as-$arisasi. Keratoati m"%-i" )%a i)mai aa eeraa asie" %a%a$

%i")a$ -ro"i- a-iat e"2$it 0ieraratiroiisme se-"er ata tersier.

. Ke$ai"a" -$it(ata$ seri"% me"%%a"%% asie"6 ato%e"esis"2a masi0 e$m )e$as a"

i%a er0"%a" e"%a" 0ieraratiroiisme se-"er. Ke$0a" %ata$ i"i a-a"

se%era 0i$a"% sete$a0 ti"a-a" aratiroie-tomi. K$it iasa"2a -eri"% a" ersisi-6

tia- )ara"% i)mai tim"a" -rista$ rea aa -$it m-a a" i"ama-a" urea

*rost

e. Ke$ai"a" se$at serosa

Ke$ai"a" se$at serosa seerti $eritis a" eri-aritis seri"% i)mai aa

%a%a$ %i")a$ -ro"i- tertama aa staim termi"a$. Ke$ai"a" se$at serosamera-a" sa$a0 sat i"i-asi mt$a- "t- se%era i$a--a" ia$isis.

f. Ke$ai"a" "erosi-iatri

Beeraa -e$ai"a" me"ta$ ri"%a" seerti emosi $ai$6 i$si6 i"som"ia6 a"

eresi seri"% i)mai aa asie" %a%a$ %i")a$ -ro"i-. Ke$ai"a" me"ta$ erat seerti

-o"fsi6 i$si6 a" tia- )ara"% e"%a" %e)a$a si-osis )%a seri"% i)mai aa

asie" ((K. Ke$ai"a" me"ta$ ri"%a" ata erat i"i seri"% i)mai aa asie"

e"%a" ata ta"a 0emoia$isis6 a" ter%a"t"% ari asar -eriaia""2a


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Pe"e-ata" ia%"osis me"7aai sasara" 2a"% i0ara-a" i$a i$a--a"

emeri-saa" 2a"% terara0 a" -ro"o$o%is6 m$ai ari a"am"esis6 emeri-saa" fisi-

ia%"osis a" emeri-saa" e"")a"% ia%"osis rti" a" -0ss.

a. A"am"esis a" emeri-saa" fisi-

A"am"esis 0ars terara0 e"%a" me"%m$-a" sema -e$0a" 2a"%

er0"%a" e"%a" rete"si ata a-m$asi to-si" a:otemia6 etio$o%i ((K6

er)a$a"a" e"2a-it termas- sema fa-tor 2a"% aat memerr- faa$ %i")a$

a. Sesai e"%a" e"2a-it 2a"% me"asari"2a. Pe"r"a" f"%si %i")a$ era e"i"%-ata" -aar rem a" -reati"i" serm6

a" e"r"a" LF( 2a"% i0it"% memer%"a-a" rms Ko7-7roft5(a$t.

Kaar -reati"i" serm sa)a tia- isa ier%"a-a" "t- memer-ira-a"

f"%si %i")a$.

7. Ke$ai"a" io-imia4i ara0 me$iti e"r"a" -aar 0emo%$oi"6 e"i"%-ata"

-aar asam rat6 0ier ata 0io-a$emia6 0io"atremia6 0ier ata

0io-$oremia6 0ierfosfatemia6 0io-a$emia6 asiosis metao$i-

. Ke$ai"a" ri"a$isis me$iti rotei"ria6 0ematri6 $e-osria

7. Pemeri-saa" e"")a"% ia%"osis

Pemeri-saa" Raio$o%is a" US(Pemeri-saa" raio$o%is a" US( e"2a-it ((K me$iti


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o Pie$o%rafi i"tra8e"a )ara"% i-er)a-a" -are"a -o"tras seri"% tia- isa

me$e4ati fi$ter %$omer$s6 i sami"% -e-0a4atira" ter)ai"2a e"%ar0

to-si- o$e0 -o"tras ter0aa %i")a$ 2a"% sa0 me"%a$ami -ersa-a"

o Pie$o%rafi a"te%ra ata retro%ra i$a--a" sesai i"i-asi

o U$traso"o%rafi %i")a$ isa memer$i0at-a" -ra" %i")a$ 2a"% me"%e7i$6

-orte-s 2a"% me"iis6 aa"2a 0iro"efrosis ata at %i")a$6 -ista6 massa6

-a$sifi-asi

o Pemeri-saa" emi"aia" %i")a$ ata re"o%rafi i-er)a-a" i$a aa i"i-asi

o Nefrotomo%ram6 ie$o%rafi retro%rae6 ie$o%rafi a"te%rae a" ,icturating

-ysto Urogra"hy


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;e%-a" a-iat -rista$isasi rea 2a"% aa aa -eri"%at6


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Mioati

Ke$ema0a" ari 0iotrofi otot5otot tertama otot5otot e-stremitas ro-sima$.

Sistem Kario8as-$er5 Hierte"si a-iat e"im"a" 7aira" a" %aram ata e"i"%-ata" a-tifitas

sistem re"i"5a%iote"si"5a$ostero".

5 N2eri aa a" sesa- "afas a-iat eri-aritis6 efsi eri-aria$6 e"2a-it

)a"t"% -oro"er a-iat atreros-$erosis 2a"% tim$ i"i6 a" %a%a$ )a"t"%

a-iat e"im"a" 7aira" a" 0ierte"si.5 (a"%%a" irama )a"t"% a-iat ateros-$erosis i"i6 %a"%%a" e$e-tro$it a"

-a$sifi-asi metastati-.

5 Eema a-iat e"im"a" 7aira".

Sistem E"o-ri"5 (a"%%a" se-sa$ > $iio6 ferti$itas a" ere-si me"r" aa $a-i5$a-i a-iat

ro-si testostero" a" sermato%e"esi me"r". Sea $ai" )%a

i0"%-a" e"%a" metao$i- terte"t osteoistrofi re"a$6 2ait osteoma$asia6 osteitis firosa6 osteos-$erosis6

a" -a$sifi-asi metastati-.

Asiosis metao$i- a-iat e"im"a" asam or%a"i- sea%ai 0asi$

metao$isme.

E$e-tro$it > 0ierfosfatemia6 0ier-a$emia6 0io-a$semia.

Kare"a aa %a%a$ %i")a$ -ro"i- te$a0 ter)ai %a"%%a" -eseima"%a"

0omeostati- aa se$r0 t06 %a"%%a" aa sat sistem a-a" ere"%ar0 aa

sistem $ai"6 se0i"%%a sat %a"%%a" metao$i- aat me"im$-a" -e$ai"a" aa

era%ai sistem@or%a" t0.

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Peme!ksaan *enun4ang

U"t- memer-at ia%"osis seri"% ier$-a" emeri-saa" e"")a"%

1= Pemeri-saa" $aoratorim

U"t- me"eta-a" aa"2a Pe"2a-it (i")a$ Kro"i-6 me"e"t-a" aa"2a

-e%a4ata"6 me"e"t-a" era)at Pe"2a-it (i")a$ Kro"i-6 me"eta-a" %a"%%a"

sistem a" mema"t me"eta-a" etio$o%i. Da$am me"eta-a" aa tia-"2a

%a%a$ %i")a$ tia- sema faa$ %i")a$ er$ i)i6 U"t- -eer$a" ra-tis 2a"%

a$i"% $a:im i)i aa$a0 (FR.

#= Pemeri-saa" EK(U"t- me$i0at -em"%-i"a" aa"2a 0iertrofi 8e"tri-e$ -iri6 ta"a ta"a

eri-aritis6 aritmia a" %a"%%a" e$e-tro$it


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T0ora foto

Daat me$i0at ta"a ta"a e""%a" ar a-iat o8er$oa 7aira" serta efsi

$era a" -ariome%a$i6 -aa"% i"fe-si roses sesifi- )%a aat item-a"

-are"a me"r""2a a2a ta0a" t0.

Raio$o%i t$a"%De"%a" raio$o%i t$a"%6 -ita aat me"7ari osteoistrofi a" -a$sifi-asi

metastati-.

&= Pemeri-saa" iosi a" 0istoato$o%i %i")a$

Di$a--a" aa asie" e"%a" -ra" %i")a$ 2a"% masi0 me"e-ati "orma$6

ima"a ia%"osa se7ara "o"i"8asif tia- isa ite%a-a". Pemeri-saa"

0istoato$o%i i"i ert)a" "t- me"%eta0i etio$o%i6 me"eta-a" terai6

ro%"osis a" me"%e8a$asi 0asi$ terai 2a"% te$a0 ieri-a". Biosi %i")a$

i-o"trai"i-asi-a" aa %i")a$ 2a"% -ra""2a sa0 me%e7i$6 %i")a$ o$i-isti-6

0ierte"si 2a"% tia- ter-e"a$i6 i"fe-si eri"efri-6 %a"%%a" eme-a" ara06

%a%a$ "aas a" oesitas.3

II$$8 Penatalaksanaan

Penatalaksanaan k'nse=at!3

.engaturan diet

Pe"%atra" asa" -a$ori> 3& -a$@-%BB iea$@0ari

Pe"%atra" asa" $ema-> 3+5'+? ari -a$ori tota$ a" me"%a""% )m$a0 2a"%

sama a"tara asam $ema- eas )e"0 a" tia- )e"0

Pe"%atra" asa" -aro0irat> &+5,+? ari -a$ori tota$

(aram #53 %ram@0ari

Fosfor>&51+ m%@-%BB@0ari. Pasie" HD >1! m%@0ari

Ka$sim> 1'++51,++ m%@0ari

Besi> 1+51/m%@0ari

Ma%"esim> #++53++ m%@0ari

Asam fo$at asie" HD> &m%

Air> )m$a0 ri" #' )am &++m$


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masi0 iereat-a" seeraa )a0 ematasa" 0ars i$a--a". Pematasa" rotei"

tia- 0a"2a me"%ra"%i -aar BUN a" m"%-i" )%a 0asi$ metao$isme rotei"

to-sis 2a"% e$m i-eta0i6 tetai )%a me"%ra"%i asa" -a$im a" fosfat6 serta

me"%ra"%i ro-si io" H 2a"% erasa$ ari rotei". (e)a$a seerti ma$6 m"ta0

a" $eti0 m"%-i" aat ierai-i

Sa$a0 sat a")ra" a%i e"erita P(K see$m iia$isis i$a--a" aa$a0

erasar-a" aa (FR sea%ai eri-t >(FR


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-eseima"%a" "atrim a$am t0 me")ai "e%atif6 ma-a aat ter)ai 0io8o$emia6

e"r"a" (FR a" %a"%%a" f"%si %i")a$.

Pengaturan minum;aira" 2a"% imi"m aa e"erita %a%a$ %i")a$ $a")t 0ars ia4asi se7ara

se-sama -are"a rasa 0as -a" $a%i et")- 2a"% aat ia-ai "t- me"%eta0i

0irasi t0.Asa" 2a"% ter$a$ eas aat me"%a-iat-a" ea" sir-$asi

me")ai er$ei0a"6 eema a" i"to-si"asi air. Sea"%-a" asa" 2a"% ter$a$ sei-it

a-a" me"%a-iat-a" e0irasi6 0iote"si a" %a"%%a" f"%si %i")a$. Atra" mm

2a"% aat i%"a-a" "t- me"e"t-a" a"2a-"2a asa" 7aira" aa$a0 )m$a0

-emi0 2a"% i-e$ar-a" se$ama #' )am tera-0ir itama0 &++ m$6 &++ m$ i"i "t-

me"%a"ti-a" ISCL


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1= Hemoia$isis

Ti"a-a" terai ia$isis tia- o$e0 ter$amat "t- me"7e%a0


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Atasi hipertensi

Biasa"2a 0ierte"si aat i-o"tro$ se7ara efe-tif e"%a" ematasa" 7aira"

a" "atrim6 o$e0 -are"a $ei0 ari *+? e"erita 0ierte"si ersifat ter%a"t"%

8o$me.Paa eeraa -ass aat ieri-a" oat a"ti0ierte"si


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e"o$a-a" 7a"%-o-a" )i-a sat saat a-a" i$a--a" e"7a"%-o-a" %i")a$.

Atasi asidosis

Asiosis metao$i- -ro"i- 2a"% ri"%a" aa e"erita remia iasa"2a a-a"me")ai stai$ aa -aar i-aro"at $asma 1, 9 #+ me @ $. Keaaa" i"i iasa"2a

tia- er-ema"% me$e4ati titi terset6 -are"a ro-si H iima"%i o$e0 ffer

ari t$a"%. Asiosi %i")a$ iasa"2a tia- ioati -e7a$i H;3 $asma tr" ia4a0

a"%-a 1& me@$6 ima"a %e)a$a %e)a$a asiosis aat m$ai tim$.Asiosis erat aat

ter7ets i$ama"a sat asiosis a-t ter)ai aa e"erita 2a"% see$m"2a sa0

me"%a$ami asiosis -ro"i- ri"%a" misa$"2a iare erat 2a"% isertai -e0i$a"%a"

H;3. Bi$a asiosis erat a-a" i-ore-ai e"%a" emeria" NaH;3 are"tera$.

Atasi osteodistrofiSa$a0 sat ti"a-a" e"%oata" tere"ti"% "t- me"7e%a0 tim$"2a

0ieraratiroisme se-"er a" se%a$a a-iat"2a aa$a0 iet re"a0 fosfat e"%a"

emeria" %e$ 2a"% aat me"%i-at fosfat a$am ss.

Diet re"a0 rotei" iasa"2a )%a me"%a""% re"a0 fosfat.Pe"%oata" i"i

seai-"2a im$ai aa a4a$ er)a$a"a" %a%a$ %i")a$ ro%resif ima"a (FR "2a m$ai

tr" 0i"%%a seerti%a "orma$. at 2a"% seri"% i%"a-a" "t- e"%i-at fosfat

aa$a0 %e$ a"tasia a$m"im.

Ji-a %a"%%a" aa ra"%-a emi-ia" 0eat -e"ati" sa0 i$a--a"

ti"a-a" e"7e%a0a" e"%a" %e$ a"tasia. Ma-a emeria" 8itami" D ara

aratiroie-tomi stota$ aat me")ai i"i-asi.

Metoe $ai" 2a"% i%"a-a" "t- me"7e%a0 osteoistrofi a"tara $ai" e"%a"

me"i"%-at-a" asa" ;a 16# 9 16& % @ 0ari a$am iet.

Atasi hiperurisemia

at i$i0a" "t- me"%oati 0ierrisemia aa P(K aa$a0 a$ori"o$.Atasi neuropati perifer

Biasa"2a "eroati erifer simtomati- tia- tim$ samai %a%a$ %i")a$

me"7aai ta0a 2a"% sa"%at $a")t. Tia- aa e"%oata" 2a"% i-eta0i "t-

me"%atasi era0a" terset -e7a$i e"%a" ia$2sis.Pengobatan segera pada infeksi

Pe"erita P(K memi$i-i -ere"ta"a" 2a"% $ei0 ti"%%i ter0aa sera"%a"

i"fe-si6 tertama i"fe-si sa$ra" -emi0. Kare"a sema )e"is i"fe-si aat

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memer-at roses -atao$isme a" me"%a"%% "trisi 2a"% aeat6 -eseima"%a"

7aira" a" e$e-tro$it ma-a i"fe-si 0ars se%era ioati.

II$$7 &'m*l!kas!12

(a%a$ %i")a$ -ro"i- aat me"2ea-a" era%ai -om$i-asi sea%ai eri-t >

5 Hier-a$emia

5 Asiosis metao$i-

5 Kom$i-asi -ario8as-$er < 0ierte"si a" ;HF =

5 Ke$ai"a" 0emato$o%i


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Da3ta Pustaka

1. S0er4oo6 L. Sistem Kemi0. Fisio$o%i Ma"sia> ari Se$ -e Sistem. Eisi #.

Ja-arta> E(;> #++1> Ba 1'> 1,151/,.

#. Stei"6Ja2 H. Ke$ai"a" %i")a$ a" e$e-tro$it. a"a" -$i"i- i$m e"2a-it

a$am.eisi -e53. Ja-arta > Pe"erit B- Keo-tera" E(;6 #++1.

3. De""is L. Kaser6 E%e"e Bra"4a$6 A"t0o"2 Fa7i. Harriso"s Pri"7i$es of

I"ter"a$ Mei7i"e 1,t0 Eitio". USA > M7(ra45Hi$$6 #++'.

'. Nisse"so". Eiemio$o%2 a" at0o%e"esis of a7te re"a$ fai$re i" t0e I;U.

Ki"e2 I"ter"atio"a$ 1**/ &3 !51+.

&. Sta$eto" FB6 Jo"es DP6 (ree" RS. A7te re"a$ fai$re i" "eo"ates> I"7ie"7e6

etio$o%2 a" ot7ome. Peiatr Ne0ro$ 1*/! 1 31'53#+.

,. A$tV"tee6 (e:%i"W6 To"$1 Etio$o%2 a" ro%"osis i" 3, a7te re"a$ fai$re

7ases re$ate to re%"a"72 i" 7e"tra$ a"ato$ia. Er J (e" Me #++& # 11+5

113.

!. Mar-m6M.H.S. (a%a$ (i")a$ A-t. I"> So2o AC6 Seti2o0ai B6 eitors.

B- A)ar> I$m Pe"2a-it Da$am. Ji$i I. Eisi -e5'. Ja-arta> Ba$ai Pe"erit

FKUI6 #++,.

/. Boei4arso"o.(a%a$ %i")a$ a-t. se%i ra-tis e"%oata" e"2a-it

a$am.Sraa2a > Pe"erit PT Bi"a I"ra Kar2a 1*/&.*. Ta-ao-a6 Kro6 Matsmra. Ro$e of e"ot0e$i" i" t0e at0o%e"esis of a7te

re"a$ fai$re. Dr% Ne4s Perse7t #+++6 13 1'1.

1+. Ra0ar)o6 J.P)i. Ke%a4ata" aa (a%a$ (i")a$. Pe"ata$a-sa"aa"

Kearrata" i ia"% I$m Pe"2a-it Da$am. Ja-arta> Psat i"fomasi a"Pe"erita" FKUI #+++.

11. Ase$i" P6 Ar2 P6 Fra"sso" s%. Efe- "efroto-si- aa asie" risi-o ti"%%i

2a"% me")a$a"i a"%io%rafi. NEJM #++, 3'/ '*1.

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1#. So2o6 A. C --. Pe"2a-it (i")a$ Kro"i-. B- A)ar I$m Pe"2a-it Da$am.

Ji$i II. Eisi . Ja-arta > Psat Pe"erita" IPD FK UI #++*. . 1+3& 9 1+'+

13. Kama$i" Ame$ia"a. #+1+. (a%a$ (i")a$ Kro"i-. Ja-arta > Ba%ia" I$m Pe"2a-itDa$am UPH.

Refrat Gagal Ginjal

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