MR CKD Tabanan

7/23/2019 MR CKD Tabanan

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MORNING REPORT

CASE

Oktober 9th

2014



PATIENT’SIDENTITY Name : I!

A"e : #0 $o

Ge%&er : ma'e

Stat() : Marr*e&

Re'*"*o% : +*%&( A&&re)) : Sa'ema&e", Taba%a%

T- : # oktober 2014 1./00



ANAMNESIS+eteroa%am%e)*)

Ch*e -om3'a*% :

bo&$ eak%e))

Pre)e%t h*)tor$ : Patient came to the emergency unit

BRSU Tabanan with chief complain bodyweakness. Patien complain weakness 3

days BAT weakness fell all o!er thebody he can"t do any acti!ity. Patien alsocomplain nausea since 3 days BAT. Thiscomplain cause the patient can"t eat.



#ont"d

e also felt nausea without !omitingsince 3 days. $t felt almost e!erydayand it worsen by food consumption

and he also complain loss ofappetite.

%e!er& headache& shortness of

breath was denied Urination and defecation were said

to be normal. Bloody urine& pain

since urinating and blackish stool



Pa)t *''%e)) h*)tor$ istory of the same complain was

denied by the patient. patients had a

history of taking medication arthritis for'( years& but the patient forgot thename of the medicine and patients hada history of gastritis

istory of )*& hipertension& heartdisease was denied.



5am*'$ h*)tor$ : +one of the family member had the same

complained as the patient

istory of T& kidney& ,$ Tract and )* wasdenied

So-*a' +*)tor$ : Patient is a farmer. e consumption of

cigarettes since young . now he smoke -cigarettes per day. #onsumption alkohol was

denied



P+YSICA6 E7AMINATION

Ge%era' a33eara%-e : Mo&erate'$ *''

6e8e' o -o%)-*o()%e)):Com3o) Me%t*)

GCS : E4M;

*ta' S*"%:

BP '((/0( mmg

RR -( 1/min

PR '(2 1/min ta1 30#

4eight 55 kg

eight '05 cm

B*$ -(&-( kg/m-



E$e) : a%em*)<=<> *-ter() ?=?>

R3 <=< *)o-or*-, oe&ema 3a'3/?=?

ENT : To%)*') T1=T1> 3har$%"ea'h$3erem*a ?> to%"(e %orma'> '*3

-$a%o)*) ?

Ne-k : @P RP < 2 -m+2O>

'$m3h %o&e e%'ar"eme%t ?



Thora : S*metr*), retra-t*o% ?Cor

$nspection $ctus cordis unseenPalpation $ctus cordis not palpablePercussion

6B at *#6 S $#S 7

RB at PS6 )Auscultation S' S- single regular& murmur 89:

Po

$nspection SymetricPalpation 7% +/ +Percussion sonor/sonorAuscultation 7es ; / ; & Rh 9/9& wh 9/9



Ab&ome% :

$nspection )istention 89:< ascites 89:

Auscultation Bowel sounds 8;: normal

Percussion TympaniPalpation Tenderness on palpation 8;:on epigastium< li!er = spleen not

palpable

Ballotment 89/9:

Etrem*t*e): 4arm ;/;< edema 9/9

;/; ;/;



Com3'ete b'oo& -o(%tParamet

erRe)('t B%*t Remark) Reere%-e

ra%"e

!C 2/2 10.=6 + 4?10

-Ne , 21/ 10.=6 + 4#,00 F 0,00

-6$ 10,4 2/; 10.=6 1.,0 F 40,0

-Mo ./;. 0,919 10.=6 2,00 F 10,00

-Eo 0/0; 0,01 10.=6 0,00 F ,00

-!a 0,41

0114 10.=6 0,0 0 F 2,00

R!C ./.. 10;=6 6 4,0 F ,0

+G! 9/2 "=&6 6 1.,00 F 1;,00+CT .0 6 40,00 F 4,00

MC 90/0 6 0,00 F100,00

MC+ 2#/# 3" 2;,00 F .4,00

MC+C .0/ "=&6 6 .2,00 F .;,00



!'oo& -hem*)tr$ 3a%e'

Parameter Re)('t B%*t Remark) Reere%-era%"e

SGOT B=6 0?0

SGPT 1# B=6 + 0?0

!BN .4 m"=&6 + ?1

Creat*%*%e 2/2 m"=&6 + 0,;0 F 1,10

G'(ko)a 111 m"=&6 + #4?10;

Natr*(m 1. Mmo'=6

1.?1

a'*(m /4 Mmo'=6

.,?,

Ch'or*&a 10; Mmo'=6

+ 9?10



>#,

sinus tachycardia 8'(2 1/minute:



ASSESMENT

*ild anemia normokromik normositer

6eukositosis

#hronic kidney disease stage $7



P6ANNING

Thera3$ ospitali?ed

$7%) +a#l (.@ -( drops/mnt

#aftria1one -1 'gr

%olic acid -1' tab

Pantopra?ole '1' tab

ndansentron 312mg



P&

?

Mo%*tor*%" 7ital sign

#omplaints



T+AN YOB



Criteria :

1. Kidney damage for≥

3 month• structural and functional abnormality

• with or without decreased Glomerular Filration

Rate (GFR)

• manifest by either abnormality of :

• athology

• blood comosition

• urine comosition

• imaging test

!. GFR " #$ ml%min for 3 month& with or without 'idney

damage



lanation :

• *tructural abnormality e.g. single 'idney&

'idney%ureter stone& cystic 'idney&

roteinuria

• +rostate hyertrohy& etc

• GFR : calculated by Koc'roft Gault Formula

• ,lood comosition e.g. ureum& creatinin

• -rine comosition e.g. roteinuria& haematuria

• maging e.g. ,/0 (lain hoto abdomen)& -*G etc



Kidney disease ≥ 3 month :

GFR (Coc'roft Gault)

≥

#$ ml%mnt%1.3 m!

Kidney damage (2) CK4

Kidney damage () normal

" #$ ml%mnt%1.3 m! CK4



Stage Description GFR

(mL/min/1.73 m2)

Actions*

I Kine! amage "it#

norma$ or GFR

≥ %& Diagnosis an treatment. 'reatment o

comori conitions S$o"ing

progression +,D ris- rection

II Kine! amage "it# mi$

GFR

&0% stimating progression

III oerate GFR 3&04% 5a$ating an treating comp$ications

I, Se5ere GFR 1402% 6reparation or -ine! rep$acement

t#erap!

, Kine! ai$re 14 or ia$!sis Rep$acement (i remia pesent)

*56G* 0F CK4: 6 C7/C67 6C50/ +76/

+#ronic Kine! Disease is eine as eit#er -ine! amage or GFR & mL/min/1.73 m2 or≥

3

mont#s. Kine! amage is eine as pat#o$ogic anorma$ities or mar-ers o amage inc$ing

anorma$ities in $oo or rine test or imaging sties

* Inc$es actions rom proceeing stages



5070G8 0F CK4

tiology of CK4 are :

1. 4iabetes 9ellitus!. Chronic Glomerulonehritis

3. Chronic +yelonehritis

. ;yertension

<. -rinary tract stone

#. 0bstruction (tumor& rostate)

. mmunological disease (*7)

=. Congenital (olycystic 'idney)

>. 9alignancy

1$. 0thers :

• regnancy

•

chronic li?er disease



7/C67 96/F*5650/ :

ymtom :

/ot secific : lethargic& wea'ness. nausea& ?omiting& headache&

edema& dysneu on effort

+hysical eamination :

;yertension& anemic& edema*ign of comlications e.g. heart hyertrohy& ascites



+atohysiology of hyertension in CK4

1. *odium retention

fail of the 'idney for ecreted water and sodium

ecess

!. 6cceleration of Renin 6ngiotensin *ystem acti?ity

increased secretion of renin



6ngiotensinogen

(roduced by li?er)

Renin(roduced by 'idney

6ngiotensin

6ngiotensin

Con?erting n@yme

(6C)

Renin Angiotensin Aldosterone System

*urarenal corte

6ldosteron

6ngiotensin



+65;0+;8*070G8 0F 6/96 / CK4

1. rythrooitin insufficiency

decreased of erythrooitin secreted by the 'idney

!. ron deficiency

chronic bleeding

low inta'e

3. 0thers haemolysis % decreased of erythrocyte li?e send

deressed of bone marrow by uraemic substances



+atients with chronic 'idney disease should be

e?aluated to determine:

1. 4iagnosis (tye of 'idney disease)

!. Comorbid conditionsA

3. *e?erityA assessed by le?el of 'idney functionA

. Comlications& related to le?el of 'idney functionA

<. Ris' for loss of 'idney functionA

#. Ris' for cardio?ascular disease



C09+7C650/ 0F CK4

1. Cardiac diseases

coronary artery disease congesti?e heart disease

acute left heart failure

!. 9etabolic acidosis

3. lectrolyte imbalance

hyer % hyo'alemia

hyer % hyonatremia

. Renal osteodystrohy (renal bone disease)



arly detection of CK4 using 'idney health chec'

Bho is at higher ris'

of 'idney disease

Bhat should be

done

;ow often

6ge <$ 8ears

4iabetes

;igh ,lood +ressure

*mo'ing

0besity

Family history of

'idney disease

,lood ressure

-rine distic'

(mircoalbuminuria if

diabetes resent)

eGFR

?ery 1! months



5reatment for chronic 'idney disease should include:

1. *ecific theray& based on diagnosis

!. ?aluation and management of comorbid conditionsA

3. *lowing the loss of 'idney function

. +re?ention and treatment of cardio?ascular diseaseA

<. +re?ention and treatment of comlications of decreased

'idney function

#. +rearation for 'idney failure and 'idney relacement

therayA. Relacement of 'idney function by dialysis and

translantation& if signs and symtoms of uremia are

resent

Documents

MR CKD Tabanan