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ISK, GLOMERULONEPHRITIS
AKUT dan KRONIS
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INFEKSI SALURAN KEMIH
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PENDAHULUAN
• ISK adalah istilah umum yangmnun!u""an "#$adaanmi"$%%$ganism dalam u$in
• &a"t$iu$ia #$ma"na mnun!u""an'$tum#uhan mi"$%%$ganism mu$nil#ih ()* colony forming unit +-u.ml/'ada #ia"an u$in0
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Terminology
UTI
Asymptomatic
Bacteriuria
Symptomatic
UTI
Cystitis
Urosepsis
Asymptomatic
UTI
Pylonephritis
Pyuria
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Causative Organisms
Community-acquired
• Escherichia coli*
• Klebsiella
pneumoniae
• Proteus mirabilis
• Staphylococcus
saprophyticus• Enterococcus faecalis
Hospital-acquired
• Escherichia coli
• Pseudomonas
aeroginosa
• Proteus sp.
• Enterobacter sp.
• Serratia sp.
• Enterococcus sp.
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Risk Factors
• Gender
(emales!males"
• A#e
• Pre#nancy andmenopause
• Use o diaphra#m
• Se$ual intercourse• %esicoureteral relu$
• Con#enital
a&normalities
• Stone ('idney or any
part o tract"• Urinary catheters
• ia&etes mellitus
• Inadequate luidinta'e
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emale Anatomy
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Male Anatomy
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KLASIFIKASI UTI
Berdasarkan Letaknya
L%1$ u''$ Un%m'liatd 2%m'liatd
U$th$itis
SistitisP$%statitisAsim'timati"#a"t$iu$i
Pyl%n-$itis
Int$a $nal 3'$in'$ia#ss
K$usa"an
st$u"tu$ 3-ungsi%nal T$a'i yang'nd" dantida"#$"lan!utan
Ada -a"t%$
'dis'%sisiPng%#atan !ang"a 'an!ang&at$ima %$$u$$ns
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PATHOGENESIS
• &a"t$i #isa #$asal d$ $tal atau4agina
• K%l%nisasi di a$a '$ianal
• &a"t$i mig$asi " a$a '$i4aginal
• &a"t$i nai" da$i u$th$a " #ladd$
• Asnding in-ti%n
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Presentasi Klinik
• )yeri suprapu&ic• * requency and ur#ency o urination• ysuria
• )octuria• Hematuria• Urin #elap• lan' or &ac' pain
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Diagnosis of UTI
• History
• Lab + “Clean catch” urine sample
- Wash genital area
- Collect midstream sample + Urinalysis + Kultur Urine + Sensitivity
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Urinalysis
arameter !ormal values U"#
Appearance ,ello Cloudy
pH ./0-1/0 Al'aline
Protein )e#ati2e Positi2e
)itrite test )e#ati2e Positi2e
3BC )e#ati2e Positi2e
4BC 5-0 6 hp ! 0 6 hp
Cast )e#ati2e Positi2e
Bacteria A&sent 7any present
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• Diagn%sis #anding
in-"si atau i$itasi 'ada '$iu$t$aatau 4agina
• K%m'li"asi'il%n-$itis a"ut
s'ti"mia
"$usa"an gin!al
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Pnatala"sanaan
• Pasin dian!u$"an #anya" minum untu"mning"at"an diu$sis
• anti#i%ti" yang ssuai
• Pnggunaan slama 5 ha$i dngan
TMP .SM6
Flu$%7uin%l%n
• Singl d%s "u$ang -"ti- "uali dnganlatams
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Gl%m$ul%n'h$itis a"ut
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Gl%m$ul%n'h$itis a"ut
• D8nisi 9 suatu $a"si imun%l%gis'ada gin!al t$hada' #a"t$i atau4i$us t$tntu0:ang s$ing t$!adi
ialah a"i#at in-"si "umanst$'t%%us0
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• Eti%l%gi ;
+ St$'t%%us #ta hm%liti"us
+ P%st in-"si St$'t%%us #tahm%liti"us
+ K$aunan timah hitam
+ T$%m#%sis 4na $nalis
+ Lu'us $itmat%sus
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'at%gnsa
T$#ntu"nya "%m'l"s antign
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"lasi8"asi
A0 K%ngnital
(0 Sind$%m Al'%$t• Adanya gl%m$ul%n-$itis '$%g$si- -amilial yang s$ing
dis$tai tuli sya$a- dan "lainan mata
• G> utamanya hmatu$i
• Hilangnya 'ndnga$an sa$a #ilat$al
• T$dt"si saat umu$ s'uluh tahunan
?0 Sind$%m N-$%ti" K%ngnital• Sin$%ma n-$%ti" yang tlah t$lihat s!a" atau #ah"an
s#lum lahi$• G> '$%tinu$i massi-, sm#a# dan
• Hi'%al#uminmia t$dt"si ##$a'a minggu . #ulan"mudian
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&0 Gl%m$ul%n-$itis '$im$(0Gl%m$ul%n-$itis mm#$an%'$%li-$asi-
Suatu gl%m$ul%n-$itis "$%ni" yang tida" di"tahuiti%l%ginya dngan g!ala yang tida" s'si8"
?0Gl%m$ul%n-$itis mm#$an%sa S$ing di !um'ai 'ada h'atitis & lu'us
$itmat%sus sistmi"
50N-$%'ati IgA +'nya"it #$g$/ N-$%'ati IgA #iasanya di!um'ai 'ada 'asin
dngan gl%m$ul%n-$itis a"ut, sind$%ma n-$%ti",
hi'$tnsi dan gagal gin!al "$%ni"
N-$%'ati IgA !uga s$ing di!um'ai 'ada "asusdngan gangguan h'a$, salu$an $na atau"lainan sndi
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20 Gl%m$ul%n-$itis s"und$◦ G%l$ul%n-$itis s"und$ yang #anya"
ditmu"an dalam "lini" yaitugl%m$ul%n-$itis 'asa st$'t%%us
◦ "uman 'ny#a# t$s$ing adalahst$'t%%us #ta hm%liti"us g$u' Ayang n-$it%gni"
◦ Gl%m$ul%n-$itis 'asa st$'t%%usdatang dngan "luhan hmatu$ia
nyata, "adang
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• Mani-stasi "lini" + P$%tinu$i
+ Hmatu$i + Sm#a#
+ Hi'$tnsi
+ Pnu$unan -ungsi gin!al
• Pm$> 8si" + U"u$ && dan T&
+ T"anan da$ah
+ Sm#a#.asits
+ Mm$i"sa adanya 'nya"it sistmi" yang#$hu#ungan dngan "lainan gin!al, misala$t$itis,$uam "ulit, ggan "a$di%4as"ul$, 'a$udan SSP
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• Pm$> la# + UL
+ LED + H#
+ &i%'si gin!al
• Png%#atan + Png%#atan su'%$ti- + Anti#i%ti"
+ O#at hi'$tnsi
+ Sdati- untu" mnnang"an P> + Ku$angi dit ga$am
+ Dialysis #ila tim#ul anu$i slama @
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• K%m'li"asi
(0 Gl%m$ul%n-$itis "$%ni"
?0 Gagal gin!al a"ut dngan mani-stasi%ligu$ia sam'ai anu$ia
50 Ensl%'ati hi'$tnsi
B0 Gangguan si$"ulasi #$u'a dis'na,%$t%'na, t$da'atnya $%n"hi #asah,'m#sa$an !antung dan mningginyat"anan da$ah yang #u"a sa!a
dis#a#"an s'asm 'm#uluh da$ah
@0 Anmia
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2h$%ni
Gl%m$ul%n'h$itis
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D8niti%ns
• 2h$%ni gl%m$ul%n'h$itis is th ad4and stag%- a g$%u' %- "idny dis%$d$s, $sulting ininCammati%n and sl%1ly 1%$sning dst$uti%n %-int$nal "idny st$utu$s alld gl%m$uli0
• This synd$%m is ha$at$i=d #y 9
'$sistnt '$%tinu$ia and %$ hmatu$ia
$nal insuiny
high #l%%d '$ssu$ +hi'$tnsi/
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2h$%ni gl%m$ul%n'h$itis usually %ms 9
+(/u'%n $%utin u$inalysis,
+?/1hn $%utin #l%%d tsts $4al un>'laindanmia %$ l4atd #l%%d u$a nit$%gn and$atinin,
+5/F%ll%1ing %- #ilat$al small "idnys %n a#d%minalimaging,
+B/Du$ing 4aluati%n -%$ s%nda$y auss %-hy'$tnsi%n, %$
+@/Du$ing a linial >a$#ati%n %-gl%m$ul%n'h$itis t$igg$d #y 'ha$yngitis+syn'ha$yngiti/ %$ %th$ in-ti%ns
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Pm> 'nun!ang
• K$atinin s$um dan #$sihan "$atinin mnilai-s0 Gin!al
• Di'sti" u$in
•Pm> mi"$%s"%'is
sl da$ah m$ah3 silind$• E"s"$si '$%tin ?B !am
• USG gin!al u"u$an gin!al
• Ts
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T$a'i
• GN lsi minimal"%$ti"%st$%id
• GN mm#$an%sa st$%id dan "l%$am#usil
• RPGN atau GN s"und$ imun%su'$si yg l#h
ag$si-, t$masu" "%$ti"%st$%id, si"l%-%s-amid,dan 'lasma-a$sis0
• Pngndalian TD, li'id, hinda$i %#at
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K%m'li"asi
• N'h$%ti synd$%m
• 2h$%ni $nal -ailu$
• End
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ASSALAM00
