jurnal gh-baru.pptx

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<



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



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!.



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



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



– 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



– 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



– 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



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+!



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



• 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



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



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.



THANKYOU…

jurnal gh-baru.pptx

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