jurnal gh-baru.pptx
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8/16/2019 JURNAL GH-BARU.pptx
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KRITERIA YANG SESUSAI MENURUT American College of Radiology (ACR)
PADA GAGAL GINJAL
Erick M. Remer, MD,a Nicholas Papaicolao!, MD," Da#i$ D. %asalio, MD,c Ja& T. 'isho(,
MD,$M. Doal$ 'la!)o*, MD, PhD,e %o!r+e& A. %o!rse&, MD,) Mairi Di-he, MD,- S+e#e %.
E"erhar$+, MD,hS+ale& Gol$)ar", MD,i o/ar$ J. ar#i, MD, Mar+a E. eil"r!, MD,k Joh R. Le&e$ecker,
MD,l Pa!l Nikolai$is, MD,c A&+eki 0+o, MD,m Gle M. Premi-er, MD, S+e#e S. Rama,MD,o Sheila She+h, MD,p Ra-h!a$a 1ikram, MD,2 Ro"er+ M. 3ei)el$, MDr
The America Jo!ral o) Me$icie 456789 75:, 7687;768<
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PENDAULUAN
• Peci+raa pe+i- pa$a pasie-a--!a -ial ak!+ 4AKI9 a+a!pe&aki+ -ial kroik 4PGK9
• Peci+raa $ipe-ar!hi oleh ko$isikliis
• Pasie $is)!-si -ial, USG
4!l+rasoo-ra=9 $apa+ > – Melacak pe&e"a" re#ersi"el
– Uk!ra -ial $a echo-eisi+as
KR0NISITAS
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Ma)aa+ Kliis
• USG peci+raa a/al !+!k e#al!asi $is)!-si-ial
mem"e$aka PGK melal!i !k!ra
-ial, eko-eisi+as, hi$roe)rosis 4?@;9, $akis+ik
• %T $e+eksi "a+! a+a! massa $e-a pe&e"a"pos+ real
•
Magnetic resonance 4MR9, A-io-ra= %T
$e+eksi s+eosis ar+eri ika $e-a USG 4;9
• Kri+eria A%R a$alah pa$!a "er"asis "!k+i ko$isi kliis +er+e+!, $i+ia! per +ah!.
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GANGGUAN GINJAL AKUT
• De=isi > – )!-si -ial +i"a;+i"a 4$lm 8< am9
– A"sol!+ krea+ii ser!m B 6. m-@$l 4B5C
!M@L9 – C6 o!+p!+ !ri 40li-o!ri 6,C mL@k-@am9
• Pe&e"a" – Pre real > ipoper)!si, ipo#olemi, s+eosis
a. realis, +rom"osis
– Real > ak!+ +!"!lar ekrosis
– Pos+ real > 0"s+r!ksi
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GANGGUAN GINJAL AKUT
• US – Gra& Scale >
• !k!ra -ial, o"s+r!ksi kroik a+a! s!" ak!+
• Jika kecil F eko-eik > proses lama, s!li+ mem"aik
• I$e+i=kasi Pe&e"a" -a--!a -ial &- $apa+ $ikoreksi40"s+r!ksi pos+ real9
• Per)!si -ial
– %olo!r Doppler US• De+eksi o"s+r!ksi !ri
• 0"s+r!ksi kompli+ !ila+eral real e+ 4;9 se+elah 76 mei+pe-ama+a.
• Pe&e"a" H MRI @ %T
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– D!ple* Doppler US e#al!asi a.realis• Ski+i-ra= ra$io!kli$e
• MRA
• Ko+ras A-io-ra= – MRI
• Real "loo$ o/
• Trom"osis #ea real "ila+eral
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– MRI?Ko+ras !-si -ial s+a"il• Mercap+oace+&l+r-il&cie 4MAG9
– De+eksi pa$a AKI i+ra real
–
Ak!m!lasi parekimal pro-resi) 4?9 +apaekskresi "ermaka Nekrosis +!"!lar ak!+
– Up+ake 4;9 ko$isi B seri!s ak!+ cor+e*ekrosis, $a ak!+ -lomer!loe)ri+is
• T%;m DTPA
– Ak!m!lasi me!r! – S!li+ "e$aka ak!+ @ kroik
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– MAG?T%;m meilai• E)ek+i=+as real o/
• Deraa+ )!-si real
• 'ermaka pro-os+ik – Pro-osis 'aik
» E)ek+i) real plasma o/ B 75C mL@mei+ F !p+ake "aik
» Ak!+ +!"!lar ekrosis, si$rom hepa+oreal, Ak!+i+ers+isial e)ri+is
– Pro-osis "!r!k !p+ake re$ah, co+oh&a Dialisis @
+raspla+asi – %T
• Tra!ma
• USG +i$ak $p+ me$e+eksi
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Pe&aki+ Gial Krois
• Pe&e"a" >
– Ne)ropa+i Dia"e+ik
– Ne)ropa+i iper+esi 5C Pe&aki+
-ial e$ s+a-e
– Glomer!loe)ri+is
– Pe&aki+ Gial Polikis+ik
– P&eloe)ropa+i kroik – 'a+!
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PENYAKIT GINJAL KR0NIS
• USG o"s+r!ksi $a pe&. Parekimali+risik, hi$roe)rosis
– USG Doppler $!ple* s+eosis a.realis
Pe&e"a" -a-al -ial• %T kis+a 4?9
• PGK ? Dialisa +emporer ko+ras +$k$ilak!ka
• Ski+i-ra= real?DTPA Tc;m $-A-io+esi co#er+i- e&m ihi"i+or "aik !+k s+eosis a.realis
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• MRA – Pe&empi+a a+erosklero+ic ori=ci!m? a. real
pro*imal
– Tekik !l+ra)as+?Ga$oli!m a.realis
• %TA – Resol!si spa+ial
– Le"ih si-ka+
•
MRI?Ga$oli!m DTPA – Ga-al -ial $e+eksi )!-si -ial
– %learace $osis kecil lo/ osmolar co+ras+ me$ia
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Real 'iopsi
• Real "iopsi perk!+a ka!sa pre $a pos+real 4;9
• Pe&. Glomer!l!s, #ask!lar, +!"!lo i+ers+isial
• I$ikasi – Pro+ei!ria, hema+!ria mikroskopik, mai)es+asi
real pe&. Sis+emik, -a-al -ial +$k spesi=k
• Komplikasi – Per$araha perie)rik sel) limi+i-, s!"kliis – Gross hema+!ria
– is+!la
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KESIMPULAN
• Dalam Peeli+ia ii $ilak!kapeilaia "e"erapa mo$ali+asimaging pa$a AKI $a PGK
• 'er$asarka +ia!a +erliha+ "ah/aUSG mer!paka pemeriksaa a/al&a- +er"aik !+!k me-e+ah!i
pe&e"a" $ari -a-al -ial, ika hasilpemeriksaa USG +i$ak mem!aska$ilak!ka pemeriksaa &a- lai&a.
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THANKYOU…
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