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SEORANG PENDERITA SINDROM NEFRITIK AKUT PASCA INFEKSI STREPTOKOKUS

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P ENDAHULUAN S n r m Nert Ak t ( NA) meu a a id o fi k i u S rp k n k mp ln g mb rn kii b r p oiu i, e e , u ua a aa l s eu a l ra d ma n g hp re s y n ds ra a a y k lia u iaii ietn i a g ieti d n a ean n rn l s s ( r tiu i k rn d r 2 g a h r d n h mau i p oen r u a g ai rm/ai a e tr s rasl d rei o i .3 Et lg S s n a b n a , et i n e rt st 1- i o i NA a g t a y k i r ) o da trn a k lia go r lp t p i r(do ai, inaa y ean n lmeuo ai rme iip t ) go r lp t p s a ifk i DLE, v s ui s d n lmeuo ai a c n e s, ak li a t n fi sh rdtr(id o Alo t. ert ee i sn r ma p r)3 i e S NA meu a a s lh s t ma ie ts kii r p k n aa au nfsa i l s n Glmeuo ert Ak t a c S rpo o u ( o r ln fi s u P s a te tk k s GNAP ) i S, dma a tra i s au p o e ia s p d tb ls i n ejd u t r s s n ma i a a u uu
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d n go r ls gna y n tra i s tlh a a y a lmeuu ijl a g ejd eea d n a s au ifk isrpo o u p d s s o a g GNAP u t n e s te tk k s a a e e rn . S b r e a g s tlh sri srpo o u tre t y i ek mb n eea tan te tk k s etnu at u srpo o u h moi k sg o p A treig t e 12 te tk k s e l iu r u t es rn i p me gn e s k l aa s lrn n fs T ra ip ro e n ifk i ui tu au a aa . ejd eid t ltnb r ia a tr 1 2 mig uu tkifk i au a ae eks r naa n g nu n e s s lrn n fsd n1 3 mig uu tkifk i ui4aa a n g nu n e s k l .6 t M e a ime y n tra ip d GNAP a aa k ns a g ejd a a S d lh s t p o e k mpe si ndma aa t o i aiu u uu r s s o lk mu i n ni d d r tb h b a a b ra s d n a a t e y n b rd r aa d rh k n ee k i e g n ni n a g ee a d lm aa g d n k mpe n u tk me e tk s au k mpe s a o lme nu mb nu u t o lk i n Ko lk i ny n b rd r aa d rhd lm mu . mpe s mu a g ee a d lm aa aa jmlh y n b n a d n wa t y n sn k tmee a u a ag ayk a ku a g ig a lk t 201

p d k plrk plrgo r lsd n tra ip r s k n a a a i - a i lmeuu a ejd eu a a e e me a i meau a t a isse k mpe n ra s k ns lli ki s itm o lme , e k i v 5 p rd n a d nmir k a ua i ea a g n a k o o g ls.7 GNAP traa s b g i p n e a p nig S ec tt e a a e y b b e t n tra iy g g lgna,y i tr i n 10 15 d r ejdn a a a ijl at eht g u u % ai k s sg g lgna d AmeiaS rk t GNAP d p t a u a a ijl i rk eia. S aa mu c ls c r s o a i ma p n e ie k tr tma n u e aa p rdk u u pd mi eua me y rn a a -n k aa d wa a mu a p d u i n ea g n k a a tu e s d a a sa s ktr4 12 th n d n a p n a u i 5 6 th n ei a a u e g n u c k sa au . Le i s rn p d lk-a id rp d wa i d n a bh eig a a a ilk aia a nt e g n a rso1, 2 : T d ka ap e i k i h s sp d rs ai 7 1. ia d rdl s k u u a a a e aa p ng ln a tre t.5 tu u oo g n etnu4GNAP meu a a p n a i gna s p rt S r p k n e y kt ijl u u ai f treig d n a ma ie ts kii b r p p n a i es rn e g n nfsa i l s eu a e y kt n y n rn a hn g a i o t ,h n a s dkts k l a g ig n ig a smtmai a y e ii e ai s d n a ma ie ts kii y n b rt d n a rso 3 e g n nfsa i l s a g ea, e g n a i n :1.M e gn a isd n GNAP d n a ma ie ts n ig t n ie S e g n nfsa i kii y n jls jrn dtmu a ,ma a da n ss l s a g ea aa g i k n n e k ig o i d ntrp meu a a ma aa p nigu tkdb h s4 a ea i r p k n s lh e t n nu ia a . Beiu dlp r a s b a k s s p n ei rk t i o k n e u h a u e d rt a a go r ln fi s a u p s a ifk i srpo o u lmeuo ert k t a c n e s te tk k s i d n a ma ie ts kii sn r m n fi ka u. e g n nfsa i l s id o ert k t n i KAS US S o a g lk-a i 14 th n S k Bai M a u e rn a ilk, au , u u l . sk r ma s kt M RS tn g l7S pe e 2004, e g n u h a i( )a g a e tmb r dn a k lh n b n k k p d waa n a tr tma s ktr eu a e g a a a jh y eua ei a maa Be g a drs k n s jk 3 h r s b lm M RS t. n k k ia a a ea ai e eu , drs k n tb ld n tn a n ei Be g a p d mu a ia a a e a a a p y r. n k k a a k meu shn g k k k d n d ea p r td n tr tma la ig a e a i a a rh eu a eua b n k klbhtria jls a t a i aiP n ei jg e g a e i el tea s a p g h r. e d rt u a h a me g lh s s k s jk 3 h r s b lm M RS drs k n n eu e a ea ai e eu , ia a a b b rp jm s tlht u b n k kp d maa t a e ea a a eea i l e g a a a t,i k mb d me ea d n t a me ak d n a p r b h n mb rt a i k d mb i e g n eu a a p ss. eani p n ei me g lhk n igb r r a o iiS li t e d rt n eu e cn ewan u a k mea a ,ttp t a n eis a BAK d n d ma e rh n ea i i k y r a t d a e m. Ri y tp n a i s b lmn a 2 mig u y n ll wa a e y kt e eu y , n g a g au p n ei me g lhp n s b tk plkd nn ei a a e d rt n eu a a , au , i a y r p d a e tn g r k n y . P n ei tlh b r b t k d ke e g o o a n a e d rt ea eo a e o tr a d ndb rk nt ama a o a, a k lh n y s d h a ieia i g c m b td n eu a n a u a me aks jks b lm b n k k mb i ea e eu e g a . 202

P d p meis a sk dtmu a k s d rn a a e rk a n i i k n e a aa e c mp s me t , tn i 17 100 mmHg n d 8 x o o ni e s 0/ s , ai 0 / ea me i p r aa a 20 xme i tmp rtr37C,b rt nt en fs n , / nt e eau 0 , b d n 47 k ,d n t g ib d n 15 c sau gz aa g a i g aa n 7 m, tts ii c k p Di mu a e e k lp k maa n mu t a u u . t k n d ma eo a e t, a n i k d dtmu a tn a n mi u u itr sTHTdtmu a i k n a d a e ma p n keu . e i kn e p mb s rn tn i T2/ t a a a hp rmifrn . e e aa o sl T2, i k d iee aig d J P + 0 c 20. u r jnu gp ra d nk d a VP R mH S aa a tn etma a e u n r l tn a mu mu, s aa d s r p r v sk lr o ma a p r r u r a a au e iue, t a dtmu a r o k d n wh e ig P d a d me i k i kn h n i a d e e zn . a a b o n dtmu a a i s s d n ,h t d n l a tk trb , i k n st e a g ai a i e e mp a ea a e srmi stmp k e e p d k d ak k d n a rl k te t a a d ma a a e u a i a k a a trb h n a. ea a a g t P meis a lb rtru me u jk a W BC e rk a n a o ao im, n nu k n 67103/lh mo lbn12 gd paee 213. 3 /lLED ,. u; e go i /l ltlt 10 u; 16 BUN 6 mgd; C 0,9mgd; T 17I lAL ; 0 /l S 8 /lAS U/ ; T 23 I lNa144, mmo/ K 4, mmo/ ab mi 3, U/ ; 4 l ; 38 l l ; lu n 2 l gd; oe tr l 8mgd. a ap meis a u iaii /lk lseo 17 /lP d e rk a n rn l s s me u jk a k k r h n( )p 55 BJ 030;e k st n nu k n e eu a + ; H ,; 1, lu o i ( ) 0; i i( ) b kei + ; i r bn( + ; e lu o i + 7 nt t + ; a tr ( ) bl u i + ) s le k st r i 3 4/ pp n a g ei o i 22 24/ pp n a g P d l a d n ; rt st a r l adn . aa a p meis a EKG ia sn sn r l8 k l me i e rk a n rma iu o ma 4 ai nt / ; f t to a stmp kk r ime ai e g nCTR 5 23% oo h rk a a ado g ld n a 4, d neu i lr k n n Bed s r a d t kii d aa , a f s pea a a . r a ak n aa l k i ts n p se dda n s sn r man fi ka u. a in iig o a id o ert k t i P d h r p ra p rwaa ,db rk n c ia a a ai etma ea tn ieia arn ita e a Na 0,% 8 ttsme i de 25 Kk l nrv n Cl 9 ee / nt it 00 , a d n 35 g a p oen P n o aa d n a ijk i a rm r ti. e g b tn e g n ne s mei rd ioo 2 x 6 5 mg ijk if r s mi 3 x t p e ns ln l 2, , ne s u o e d 20 mgd nc po rl x25mg Di k k nmo i rn a a tp i 2 . l ua a nt ig o k s i a g n c ia , lkr l s ratn avtl P d e emb n a arn ee toi et a d i . a a t a h r k t a p rwaa , k lh n b n k k b r u a g ai ei g ea tn eu a e g a ek rn f r s mi 40 mg db rk n s c r o a 1 k l s h r. uo e d ieia e aa rl ai e ai Dio s la dvs k r ilg, iaa k np meis a k n uk n iii adoo ids rn a e rk a n e o ado r d n a h slrk s i rg r i s tiil k k r ig a e g n a itiu pd e u gt irva, a d ndb rk ntrp meidg xn1 k ls h r. a ieia ea i t io i l ai e ai Ha i p meis a s r mak rHBs d n a t sl e rk a n eo r e Ag a ni HCV n g t .AS e ai f TO 200 I ml h CRP 2, mgl U/ , s 32 / . P oen Es a h me u jk a a a y p oen ra r ti bc n nu k n d n a r tiu i s b s r 25g a l e/aiUS a d me dd p ta e e a 3, rm/ trh r. G b o n ia ak n i n fi sgna k n nd nkr, pe o g l a i sd n ert ijl a a a ii s ln me ai st a i , e
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eu i lr. sl e rk a nANA ts n g t , wa f s pea Ha i p meis a e t e ai s b f tn g r kdtmu a h sl o i f d n aS rpo o c s e g o o i k n a ip st a a y te tc c u e i vrd n , ap a h moi k s s n i f tr a a iia s lh e l iu , e st t i eh d p a t k o a a ii i, a xcl n eyh o cn ni r b mpcl n mo ii i, r tr my i, mi l l s la tm/eo ea o s ra i p n m.Bed s r a ub ca c f p rz n et mie e r a ak n d t p n na g b rk t d aa , p se dda n s aa e u jn eiu i ts a in iig o a sn r man fi ka u p s aifk i te tk k s id o ert k t a c n e s srpo o u . i P d h r k d lp n p rwaa , trp a t a a ai e ea a ea tn ea i ni hp re s c po rldt g ak n d ss y me jd 2 ietn i a tp i i n k ta o in a na i i x5 mg k rn tr e tk n nd rhdb wa 140/0 0 , ae a ag t e a a aa ia h 8 mmHg b lm tra a.Keu a b n k k me ak eu ec p i lh n e g a mb i p d p rwaa h r k s p lh trp f r s mi a a ea tn ai e e uu , ea i u o e d d n mei rd ioo dh nia . Hai k d a ea a t p e ns ln ie t n l k r e u b ls p rwaa ,k lh n p n ei me ak drn a a a ea tn eu a e d rt a mb i, ie c n k n rwa jln d n a p mb ra trp c po rl2 x 5 a t aa e g n e ein ea i a tp i 0 mgd nmei dg xn0, mg1 k l s h r. s rn a a t io i 1 l ai e aiDiaa k n k nr l oil i n foo i a k r ilg. o to p l i s er lg d n adoo i kn P BAHAS EM AN S n r m n fi ka u p s aifk i te tk k s id o ert k t a c n e s srpo o u i d n a g jl kii y n jls tr s k p n a i e g n eaa l s a g ea ema u e y kt n d n a isd n y n t a trau t g i s ktr e g n n ie a g i k ell i g, e i d n a 1 : 10. 000. S n r m n fi k a u p s a ifk i id o ert k t a c n e s i srpo o u tn ag jl isd n y me c p i u a te tk k s a p eaa n ie n a n a a jmlh 4 5 k l lbh b n a . ai e i a y k Umu y me y rn s mu mn a n ea g e a u i, a ntr tmalk-a i sa3 7th n sa n mu eua a ilk u i au . Dig o i sn r ma n fi k a u db a a n ss id o ert i k t iu t b r a ak na a y :ioiu ii e e (i hp re s ed s r a d n a () l r(i d ma i ) ietn i g ) i s ra(v k lia u iaii b r p p oen r k rn et i) ean n rn l s eu a r tiu i u a g s d r 2 g a h r d n h mau is ra sl d rei o i ai rm/ai a e tr et i n e rt st i r . Na n p d b b rp k p sa a n ds b ta mu a a e ea a e u tk a ie uk n p oen r ma i d p ttra ip d 2 5 p n ei r tiu i sf a a ejd a a % e d rt a GNAP u i mu a b h a d p tme y r p is au S sa d , a k n a a n eu a u t g mb rn p oen r p d sn r m n foi. P d a aa r tiu i a a id o er t k aa p n ei ( a u )tre u d aa , ie k n tg d r e d rt k s s e s b t its d tmu a i a a i a e a k ie i y n tr e u iy iu a a y e e mp t rtra a g e p n h at d n a d ma p d s l r ht b h h p re s g a eI, e t k li a a a eu u u u , i e tn i r d I s ra ean n u i aii b r p h mau i 22 24/ p n p n a g rn lss e u a e tra l ag adn a d np oen ra3, g a l e/ai a r tiu i 25 rm/ trh r. i

Dig o i b n i g tr e a sn r m n fii a n ss a d n e d k t i d o e rtk a u p s ai f k i te t k k sa aa p n e a li k t a c n e s sr p o o u d lh e y b b an d r sn r m n fii a u y iu p n a i- e y k t ai id o e rtk k t at e y k tp n a i p r n i g n a b i p i r ma p n s k n e, a e k m i jl ak rme uu eudr s p ri g o r l n fii a u n n sr p o o u , e e t l me u o e rts k t o te t k k s n fo aiI A,sse k l p se ie t s s p r u a er p t g itmi u u rtmao u , u p r He o h S h e li , sn r ma Go d P su e d n n c - c o n en i d o o - a tr, a g a u o t ss W e e e. P d T b l 1 b rk t r n l mao i gnr aa ae eiu d u ak n s c r sn k tg mb r n h so o i s ra i r i a e a a i g a a a a it l g s e t p t g n ss ma i g ma i g d a n s b n i g d r ao e e i sn - sn ig o a a d n a i S p s ai f k i te t k k s4- , NA a c n e s sr p o o u .57
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S o a gP n ei S n r m Nert Ak t a c I fk i te tk k s e rn e d rt id o a fi k u P s a n e s S rpo o u i Ni Made Renny A Rena, Ketut Suwitra

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sse k mpe n S lnun a sse k mpe n itm o lme . ea jty itm o lme me r d k i a t ao k mpe n 5 ( a d n mp o u s ki tr o lme a C5 ) a v me itrme itrn a s lin a S tknd nfko dao - dao i ma ian y . i i a a tr o p miu i nts s llr lin a a a me i uk n e c mu i a eue an y k n nmb la rs o ia s d n a ma ie ts p oiea i e d n e p n n ma i e g n nfsa i r l rs s l a f 3,8 11 e e go r lr d ma lmeua. P n r n n lj l a igo r lsb r u u g n e u u a au t s lmeuu eh b n a r d n a p n r n n k e se uta l a igo r ls e g n e u u a o in l t s lmeuu . r r P n r n n lj l a igo r ls diuip n r n n e u u a au t s lmeuu i t e u u a r k e s rs aa k n ia ra s r s n tim s hn g k k e i tu e ak n e b o b i aru e ig a tr a a p nmb n n n tim d n a ars lnun a ed p t e i u a aru e g n i ea jty a a diui e ak nv lmepa mad nv lmec ia k n i tk n ia ou k ls a ou arn 204

e srs llr s hn g a a t u g mb rn kii k ta eua e ig a k n i l a aa l s mb n oiu i, ietn ie e d nb n u g nsr ua i l ra hp re s, d ma a e d n a ik ls. g Ed ma tra i p d 8 % p se S e ejd a a 5 a in NA p s a ac ifk isrpo o u ,ba a y tra ime d d k d n n e s te tk k s is n a ejd n aa a p ra k ltra i i a rhp ro btl a s lnun a etma aiejd d d ea eir i d n ea jty a d p t na i d maa a ak . rjt ea rn a n a a a me jd e e n s r a Deaa b rt ig n y e e y n tra itr a tn p d b b rp fko d ma a g ejd eg nu g a a e ea a a tr y i la n a k r s k n go rls y n tra i at u s y eu a a lmo eu a g ejd, u a u a c ia , a d rjt io lu n mi. s p n arn d n eaa hp ab mie a He tr ma r k s i tra is ktr30 5 mau i k o o ps ejd e i a 0% p d p n ei S a a e d rt NA p s a srpo o u .M a ie ts a a c te tk k s nfsa i y n t u u ie d p tb r r a s p ric l,th a g i l rn a a ewan e et oa e mb aa p nk r hd ns rn d n a oiu i tu u eu a eig e g n l r. g Hietn i r p k ntn ak r ia k t ab g p re s meu a a a d adn l ei a i g S p s aifk i te tk k s dlp r a 5 9 NA a c n e s srpo o u , i o k n 0 a 0% d r p n ei y n drwa d n a go lr n fi s ai e d rt a g ia t e g n lmeu o ert a i a u. dn h m3 me g n k p a hp tsstra iy k tLe ig a n u g a k n ioe i ejdn a hp re s mu g i a ia d r d a aa t a fko ietn i n kn kb t ai u tu i a tr g b rk t at, a g u nk s i a g nn tim, ea a eiu y i g n g a e emb n a aru p rn n u sse rnn a goe sn g n d n s b tn i rn l itm e i n itn io e a u sa s e a medul h o iv f to , iu ap o tga dn l ary yp tens e ac rs dd g r sa ln i. Be d n a sr ua i b n a tra i p d n u g n ik ls a y k ejd aa p n ei y n drwa d r ma s kt M a ie ts e d rt a g ia t i u h a i a . nfsa i kii y n tmp k d p tb r p d s n u o to n u l s a g a a a a eu a y p e , rh p e , n b tkd ne e p r . au a d ma au P d p meis a lb rtru a a e rk a n a o ao im, dtmu a i kn e k lia u iaii b r p p oen r b r ia a tr ean n rn l s eu a r tiu i eks r naa s 2 4 g a p rh r,tr iid r p oen d n a b rt rm e ai edr ai r ti e g n ea moe u b s reua ab mi. mau id n a aa lk l e a tr tma lu n He tr, e g n tu tn a sl d rei o i dtmu a p d kr- ia 40% a p i n e rt st i k n a a iakr i r e p se .S l d rei o i meu a a tn a k r s k n a in i n e rt st r p k n a d eu a a i r p rn i ma i a t . n e ta i rin Deg ae km sh ki Ko s nrs Fib f radatio n Pro t ( DP me ig a,p d p se - a in b rt duc F ) nn k t a a a in p se ea tr tma y n b r b h me jd rap y p g s e eua a g eu a na i idl ro resiv go lmerulnep ritis P n nu nk n e ta i DPd lm o h . e e ta o s nrs F aa u i s n a p nig u tk me e tk n p o n ss rn a g t e t n nu n nu a r g o i sn r m n fi ka u p s aifk ite tk k sBik n id o ert k t a c n e ssrpo o u . a a i u i p d s t p p n a i gna a a u jg ,k rn rn a a ei e y kt ijl p p n u a ae a a ifk i au a k mi s rn k ltre u y d nt a n e s s lrn e h eig aies mb n i a i k d me eia k lh n P d sn r m n fi ka u p s a mb rk n eu a . a a id o ert k t a c i ifk i te tk k s ia jrn djmp i ean nu i n e s srpo o u t k aa g i d u a k lia rn
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y n me y r p in e s:e o i r d nsl d r e o i a g n eu a ifk ilk st i a i n e lk st u i waa p nt a tr u ts c r b keilgsme d rt lu u i k eb ki e aa a troo i n ei d a ifk i s k n e. Be ea a s mb r me y b ta ne s e u d r b rp u e n e uk n 38 k d n - a a gtra i lk s r. a a g k d n ejd gu o u i P d p meis a fa gna s rn dg n k n a a e rk a n a l ijl eig iu a a u e m, k e t i s r m, d n p nenh n k e t i ru rai n eu n a e jr ia rai n n me e tk n d rjt fa Lau F l a i Glmeuu n nu a eaa a l j i rs t o r ls ( G) Ko ia id r k t a p r mee iis n a LF . mbn s ai ei aa tr n a g t g p nig S p ridk th i u e m s r m t a tp t e t . e et iea u, ru eu i k e a n d u tk me ekrk n fa LF k rn : () u e m nu mp r ia a a l G ae a a ru t a h n a dl a i oe go r ls ttp a a i k a y i t s lh lmeuu ea i k n d r drb o p ijg oe tb ls gna,( )k n e ta i ie s r s u a lh u uu ijl b o s nrs u e m tr a tn d r de p oen d n k tb l me ru eg nu g ai it r ti a aa oi s p oen Waa p n d miin p n nu n u e m s r m r ti. lu u e ka e e ta ru eu p nigu tkme e tk nd rjt aa oimep oen e t nu n n nu a eaa k tb l s r ti. S r m k e t i lbh tp td r u e m s r m u tk eu rai n e i e a ai ru eu nu n me ekrk n fa LF k rn k n e ta is r m mp r ia a a l G ae a o s nrs eu k eii s maamaa tr a tn d r ma a oo- tt rt n e t- t eg nu g ai s ttoo n d n fa LF M a aoo- ttrlt k n tn s hn g a a l G. s ttoo eai o sa e ig a f s r m k e t i s maamaatr a tn d r fa LF eu rai n e t- t eg nu g ai a l G. n Be ea a k r ga d r nli p nenh n k e t i: b rp eu in ai i a e jr ia rai n n ()s rn dtmu a k n ia s mu d r p se ( ) a eig i k n e ak n e e ai a in b s rn tr a a k s lh n s lma p n mp n a u i eig ed p t e aa a ea e a u g n rn 24 jm. a ag n g a fa tb lstr tmae s rs a P d a g u n a l u uu eua k kei ee toi P d p se d n a oiu iaa a u it a lkr l . a a a in e g n l r tu n r i k t g d jrn dtmu a hp r ae . aa g i k n iek lmi e P d p meis a d rh dtmu a a e a a a e rk a n aa i k n n mi e rn a n r k r d n n r str k rn rtn i ig n o mo o m a o mo i e ae a ee s n tim d n h mo i s. P d s da n d rh tp aru a e dl i a a e ia aa e i u djmp isso i fa me ts ei o i ds ra tn a i u a itst rg na i rt st ieti a d , r tn a mir a go ai Lau e d p n d rh me ig i ad k o n ip t . j n a a aa nn g waa p n t a me u y i at da n ss ma p n lu u i k d mp n a ri ig o i uu p o n ss J mlh lk std n to o i ma i d lm r g o i. u a e o i a r mb st sh aa b tsn r lP d p se b rteua RP s rn aa o ma. a a a in ea tr tma GN eig djmp i g n g a p r aa a y n me u y i i u a a g u n ed rh n a g mp n a h b n a d n a to o i p naaa g n g a fa u u g n e g n r mb st e i tu a g u n a l o to o i(r mb p t . a ab b rp p se mu g i r mb st to o ai P d e ea a a in n kn ) tr a a p n r n n p oen s r m tr tma ab mi ed p t e u u a r ti eu eua lu n a ia rtn i n tim d n e s a s v lme c ia kb t ee s aru a k p n i ou arn e srs llr Hiel ie rn a d n s me tr, k ta eue. p ri d mi ig n a e naa p me a ime y t a dk th i Hiel ie k ns n a i k iea u. p ri d mi ii d p n
S o a gP n ei S n r m Nert Ak t a c I fk i te tk k s e rn e d rt id o a fi k u P s a n e s S rpo o u i Ni Made Renny A Rena, Ketut Suwitra

t a me u y i u u g nd n a d rjt e u u a i k mp n a h b n a e g n eaa p n r n n d ab mi s p ri a asn r m n foi. lu n e etp d id o er t k P d p meis a b keilgs dtmu a a a e rk a n a troo i i k n e p n e aa g a meh l ebu d nba a d r b h n e g c tn rm/ tyi le a ik n ai a a n p meis a h p s tn g r k n aa p s (mp t o e rk a n a u e g o o a tu u i ei ) g u tkioa i a ie t k s srpo o u . sl ik n nu s ls d n d ni a i te tk k s Ha iba a p st dtmu a h n a25 d r p se - a in y n o i f i k n a y % ai a in p se a g i e t a me d p t a t it s lma ifk i a u oe i k n a a ni oi ea d b k n e s k t lh srpo o u . el dc tt b h h sl ik np st te tk k s P ru iaa, a wa a i ba a o i f i b lm d p t ma t a eilg go r ln fi s k t eu a a me si n t o i lmeuo ert a u k o i mu g i h n ameu a a ifk i e u d rKe ak n n kn a y r p k n n e s s k n e. n ia t e a t srpoii O ( O)h n adtmu a p d i r ni te tl n AS t s ay i e kn aa 8 0% p se - a in y n t a me d p t a t it a in p se a g i k d n a a ni oi b k s lma fs d r ifk isrpo o u .Ke ak n t e ea a e ai n e s te tk k s n ia i r t AS d p tdjmp ip d b b rp k a a n s p ri O aa i u a a a e ea a e d a e et p mb wa k ma ( air, hp r oe tr lmi d n e a u n k re) iek lseoe , a ifk isrpo o u y n b r ttp b k n b ria n e s te tk k s a g au ea i u a esft n fi g nk3ert e i.5 o P meis a p n na g p n i a n d n a e rk a n e u jn e ct a r egn uta o o r l s n ga r dp r lh a a y ieoe d n a p mb s rn e e aa rn a gna bltrld n a b b rp k s s y n ig n ijl i ea e g n e ea a a u a g a me u jk a a a y p nn k tn e o e e i s F t n nu k n d n a e ig aa k g n st . oo a trk s rn dtmu a g mb rn k n e t v n o a s eig i k n a aa o g si e a e s nrl i rahlss s a d n a p nn k tnv lme e ta d ae i e u i e g n e ig aa ou u 4e srs llr 7 k ta eue. P d k s s g jl kii y n t u a aa a a a u , eaa l s a g i l d lh n mb a a y e e a a ak ,hp re s g a e d a s ra d n a d ma n s r a ietn i rd u , et k lia u iaii b r p h mau i d n p oen r. ean n rn l s eu a e tr a r tiu i s S b lmn a tr a a p ro e ltn s ktr2 mig u e eu y ed p t eid ae e i a ng s tlh p n ei trea g s au ifk is lrn n fs eea e d rt es rn u t n e s au a aa a aa . Ha i p meis a lb rtru me u jk a ts sl e rk a n a o ao im n nu k n h mau id n p oen r p d u iaii,p meis a e tr a r tiu i a a rn l s e rk a n s b keilgss btn g r kdtmu a Ste tc c u a troo i wa e g o o i k n rpo o c s e vrd n ap a h moi c s s ra s r lg AS iia s lh e l iu , et eoo i TO 200 t I mld n ANA ts n g t .P meis a p n i a n U/ a e e ai e rk a n e ct a f r US me u jk a a a y n fi s gna d xr d n G n nu k n d n a ert ijl e ta a i snsr. iita P n tlk a a n y n drk me d s p d e aaa s n a a g ie o n a i a a p n ei S e d rt NA p s srpo o u a aa trp a o t te tk k s d lh ea i smtmai y n b r a a p d d rjt k p rh n i o t a g ed s r a a eaa e aa a k p n a i s c r kii.T ja ua d r p n o aa e y kt e aa l s uu n tma ai e g b tn n 205

a aa me g n aia hp re s d n e e .S lma d lh n e d l n ietn i a d ma ea k fs a u, p n ei db ts a t i s y d n a a e k t e d rt iaa i ki t n a e g n a va p mb ra de 35 k l g b rt b d n p r ai e ein it a/ k ea a a eh r, p mb ts n de p oen h wa i0, 0, g a k e aa a it r ti e n 5 7 rm/g b rt a a p r ailma tkjn h d nrn a g rm ea b d n eh r,e k a e u , a e d h aa y i 2 g a n tim p r ai As p n ee toi p n at u rm aru eh r. u a lkr l u t h r sdb ts. tim 20 me p r airn a k l m au iaa iNaru q eh r, e d h ai u y i k rn d r 7 9 me p r ais ra k lim at u a g ai 0 u 0 q eh r et asu 6 1000 mg p r ai Re tis c ia s c r k tt 00 eh r. srk i arn e aa ea d n a p mb ts nc ia ma u 1 l e p r ai g n e g n e aa a arn s k i r eh r, u a t 3, me g ts hp re s.9n aa i ietn i 14 P n o aa hp re s d p t d n a me g e g b tn ietn i a a e g n ng n k n du ei k a,aa bl hp re s ttp t a u a a irt u t tu i ietn i ea i k k a d trts pl a o a s lnun a a aa g ln a eaa i i h n b t ea jty d lh oo g n i c c alium c annelbo k ACE inh ito aa b h a h lc er, ib r tu a k n nto r sd ita e a b g hp re s main .P d i p u i nrv n a i ietn i l a a a r g b b rp k s s b rt d n a k n ii hp r ae e ea a a u ea e g n o ds iek lmi d n sn r m u e a y n b rtdidk sk n u tk a id o rmi a g ea i ia ia nu n h mo il a e dai . s T rp seod ita e a tr tma didk sk n ea i tr i nrv n eua i ia ia n u tkgo r ln fi st ek e e t d n a la ls nu lmeuo ert i rs ni e g n u s e i i p k lbhd r 30% go r lsttlM eip e ns ln5 e i ai lmeuu oa. t rd ioo 00 l mg ita e a p r aitr a id lm 4 d sss lma 3 nrv n eh r eb g aa o i ea 5h r. mu b b rp rfrn i n e uk nt a aiNa n e ea a eee s me y b ta i k d didk sk n u tk p mb ra trp seod d lm i ia ia nu e ein ea i tr i aa n jn k p na g4a g a a jn .5 Aniit a didk sk n u tk p n o aa t oi b k i ia ia nu n e g b tn ifk i srpo o u .P l a o a y n drk me n e s te tk k s i h n b t a g ie o n i d sk n a aa p ncl n G o a 4 x 25 mg s lma7 a ia d lh e ii i l rl 0 ea 10 h r. ai P n ei p d k s s n db rk nde 25 Kk l e d rt a a a u ii ieia it 00 a a d nt g i r ti. e g b tnd n a ijk i h n x a i g p oen P n o aa e g n ne s p e o y n mei rd ioo 2 x 6 5 mg ijk if r s mi 3 x t p e ns ln l 2, , ne s u o e d 20 mgd nk po rl x25mg Di k k nmo i rn a a tp i 2 . l ua a nt ig o k s i a g nc ia , lkr l s ratn avtl e aa e emb n a arn ee toi et a d i s c r t a k tt ea. P d u mn a tr a a 4 k mu g ia a a mu y ed p t e n kn n p raa a p n a i d r sn r m n fi s a u p s a ejln n e y kt ai id o ert k t a c i ifk i te tk k s y i k mains lmama aa u n e s srpo o u , at e t ea u a s kt d p t ds b b a ifk i s k n e tr tma ifk i a a ie a k n n e s e u d r eua ne s p r ( n u na,b n u g n p r a u,e s flp t au p e mo i) e d n a au k t n eao ai 206

hp re sf d nhp r ae . g ak mainba a y ietn i, a iek lmiAn k e t is n a a k rn d r 5 b r a k mau n trp mian a u a g ai % ek t e ja ea i s ly p mb ra o a- b ta t ietn iy n p tnk a, e ein b to a ni p re s a g oe /u t h h mo il i/ei n adaii, d n ta s lna i e dai sp rt e lil s s o s a rn pa ts 3, gna.15 ijl S b ga p se go r ln p rt a u ( e a in a in lmeuo e h i s k t 5 i 10%) me el ak n t e p raa a p n a i mp ri ta i h p ejln n e y kt y n c p td n p o rsf ds ra oiu id n a u i a g e a a r g e i ieti l r a n r, g d p t me ig a d lm wa t 2 3 b ln y n aa nn g l aa ku ua , a g ds b t jg d n a sn r m Rap y Pro resiv ie u u a e g n id o idl g se Glmerulnep ritis( GN) T p p raa a p n a i o o h RP . ie ejln n e y kt iitr tma me g n ip se - a in d wa a Geaa n eua n e a a in p se e s . jl kii oiu i d n a u i y n t u s me tr, l s l r a n r a g i l e naa n g mb t a s ll me u jk n p o n ss y n b r k i k eau d n nu a rg o i a g uu . P d u mn a p o n ss d p t drmak n h n a a a mu y r g o i a a ia la a y b r a ak n k lia - ean n hso aoo i b r p ed s r a ean n k lia itp tlgs eu a p oiea i k tak plry n e se sfmeiui e i r l rs e sr a i a g k tn i l t lbh f e p d r 7 % go r l Kean n lb rtru y n ai 5 lmeui . lia a o ao im a g me c rg k n p raa a p n a i y n p o rsf n u ia a ejln n e y kt a g r g e i s p rik n ia c ul e et e ak n irc ating b g d n aa F rino en a tu DP u i,ds mpn oiu id n a u iy n b ra g u g rn ia ig l r a n r a g eln s n g lma s lmab b rp mig u a , ea e ea a n g . T ra i go r ln fi s k o i, bl s lma ejd lmeuo ert r ns i ea i a p raa a p n a i dtmu a s t aa lbh tn a ejln n e y kt i k n au tu e i a d e kii, aa p oen r d n a aa tn a h mau i l s tu r tiu i e g n tu a p e tr n a i o t y n me ea s lma b ra u -a u smtmai a g k n tp ea eth n th n a a b r b h me jd k o i, d n a hr y g g l k n eu a na i r ns a k in a a a gna k o i. rk e s p raa a p n a iii e d h ijl r ns F e u n i ejln n e y ktn rn a , a tr 5 10%.S b ga d r p se - a in ma i naa e a in ai a in p se sh me u y i k lia - ean n hso aoo i tn a mp n a ean n k lia itp tlgs a p g jl kii d nd p t iu n r l eaa l s a a a hd p o ma. n P n e u a kii ds ra p n e u a e y mb h n l s ieti e y mb h n n lb rtru ba a y b rn s ra g u d n a hr y a o ao im is n a ea g u -n s r a k in a tra i p n e u a s mp r a Be tk p raa a ejd e y mb h n e u n . nu ejln n p n a i iip l g s rn dtmu a tr tma p d e y kt n ai eig i k n eua n e aa p se a a -n k ( 0 8 %) Geaag jl kii a in n k a a 8 5 . jl- eaa l s n s p ri d map r a u, ietn ie e d noiu i e ete e au k thp re s, d ma a l r, g s g r hln s tlh tra idu e i, is n as tlh e ea i g eea ejd irss ba a y eea a b b rp h r/ n g . lia s dme u i tr tma e ea a ai g u Kean n e i n rn eua mi h mau i mir s o i b r hln s tlh b b rp e tr k o k ps au i g eea e ea a a b ln b h a hn g b b rp th n ua , a k n ig a e ea a a u .
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RI NGKAS AN T lh dlp r a k s s s o a g lk-a i 14 ea i o k n a u e rn a ilk, a th n s k Baiy n dda n ss d n a sn r ma a u , u u l a g iig o i e g n id o n fi k a u p s a ifk i srpo o u . Dig o i ert k t a c n e s te tk k s a n ss i dtg k a b r a a a a e ab n k ks lr htb h i a k n ed s r n mn s e g a eu u u u , e k n igb r r ak mea a d ns dkt rwa a s kt e cn ewan e rh n a e ii i y t a i , tn g r k n 2 mig u s b lm M RS P meis a e g oo a n g e eu . e rk a n sk dd p ta p n ei d n a hp re s g a e i ia ak n e d rt e g n ietn i rd a I,e e a a ak d n a p meis a p n na g I d ma n s r a e g n e rk a n e u jn lb rtru dd p ta g o s h mau i p oen r, a o ao im ia ak n r s e tr, r tiu i AS 200 I ml p oene b c 3, g a l e/ai TO U/ , r ti s a h 25 rm/ trh r, i ANA ts n g t d n s b tn g r k dd p ta e t e ai a wa e g o o ia ak n f S rpo o c svrd n ,ap ah moi c s Ra ilgs te tc c u iia s lh e l iu . doo i t dp r lh CTR 5 23%, eu i pe r d xr. US ieoe 4, f s lu a e ta G gna me u jk a a a y n fi sgna d xr d n ijl n nu k n d n a ert ijl e ta a i snsr. o ado r me u jk a a a y tiu pd iita Ek k r ig a n nu k n d n a rk s i rg r i s tiil P n ei me eia rs o e u gt i rva. e d rt a a mb rk n e p n y n b i tr a a k rio tr i, y i p e o y a g ak eh d p o t seod at h n x k u mei rd ioo , irt as raACE ihbtr t p e ns ln du ei et l k n ii . o DAF AR RUJ T UKAN 1. M e sn LM , P k LK, T en y LM . sia a ir e Glmeuo e h o ahe . I : T en y LM , o r ln p r p tis n ir e M c h e S , P p d ks M A, e i r. La g P e J aaai dt s o ne r d c re tme ia da n ss& te t n.43 e . u rn dc l ig o i rame t d P i d lha La g M e ia Bo k / c a hl ep i: n e a dc l o sM Grw Hi ; l 2004..8 9 l p8 2- 0. Brd HR, O e r YM , Brn e BM . ay M aa enr Glmeua ds a e I :De nsLK,F u iAS o r lr ie s . n ni ac , Brn l E,Ha s rS Lo g DL,J me o a wad u e L, n o a sn J e i r. Hars ns p icpe o itr a L, dt s o rio rn ils f nen l me iie 16h e .Ne Yo k M c Grw Hi ; dcn , t d w r: a l l 2005p16 4- 8 .. 7 8 . En a S Ner lg kii,e iiI.Ba d n : d y . foo i l k ds I n u g n I 19 7p145 6 TB; 9 .. - 3. Tai rvs L. Ac t ue p ssrpo o c l o tte tc c a go r ln p rt . Av i be fo lmeuo e h i s i al l r m: ht: a t / p/ www.M e iie e dcn a ue ct p ssrpo o c l o tte tc c a go r ln p rt . e s do : hJ n2005 lmeuo e h i s Ac se n 12t u i .

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Ge ta Glmeuo e h i sp ssrpo o c l eh D. o r ln p rt , o tte tc c a. i Av i be fo al l a r m: ht: www.M e iie t / p/ e dcn go r ln p rt ,p ssrpo o c l Ac se lmeuo e h i s o tte tc c a. e s d i o : hJ n2005 n 12t u . M a re ue n H. Ac t ue p ssrpo o c l o tte tc c a go r ln p rt . Av i be fo lmeuo e h i s i al l r m: ht: a t / p/ www.ie t ps c lf s e . om/ a oz e y/ c e gm/ t / nc a ut _ p ssr p o o c l g o r l n p rtsjp o tte t c c a _ l me u o e h ii.s . Ac se o : hJ n2005 e s d n 12t u Vie nn CS , Ol er i ia v DBG. Ac t ue go r ln p rt . P sg a u td M e ia lmeuo e h i s i o trd ae dc l J un l o r a 2003;9206 13. 7: S t mi h J. F Ac t ue p ssrpo o c l o tte tc c a go r ln p rt . albefo ht: www. lmeuo e h i s Av i l r m: t / i a p/ c cirr.r /Ac se o : hJ n2005 h l ayo g. e s d n 12t u b F a ss oL. a p rsciia n p r lg . r e . rn ic P p e l c l e h oo y 3 d d n Bo tn Li l, o a d Co a y I c 19 3. so : t eBr wn n t mp n n ; 9 p142- 0. . 5 T ms n CRV.Ke tpc i rn l me iie o o y o is n e a dcn . Ox o d BI f r : OS S ini c P bih r Li td ce t ul e s mi ; e 19 7p139 43. 9 .. Glso k RJ Co e AH,Ade S P i r as c , hn lr G. rmay go r lrds a e .I :Brn e B,Re trF lmeua ie s s n e n r co , e i r.Th kd e .6h e .P i d lha W B dt s e in y t d hl ep i: o a S u d r Co 2000.. 2a n es ; p139 402. Ro rg e -tr e B. P sifcis go r ld iu zIu b ot et n u lmeuo n p rt . JKin yDi 2000; ( : - . e h i s Am i de s 35 1)46 8 Ge d s C. Th te t n o iip ti de e rame t f do ahc me rn u n p r p ty S mi Ne h o mb a o s e h o ah . e n p rl 2000; 29 . 20; 9 Xi n B,Ed a L,Erc S Glra S Be ti me a d i , o i , arz G, I g i R. P s srpo o c l a ue n rd o t te tc c a ct go r ln p rt . I : Xi n B, e i r lmeuo e h i s n i me a dt . o P darc Ne h oo y P i d lha W B e iti p r lg . hl ep i: a S u d r Co 2000.. 6 6 . a n es ; p45 - 7 P niel C.Ca p oo g d te t n i r v ot l c i n r ln e rame t mp o e te p o n ss i a ut wi f c l s g na h rg o i n d l s t o a e me tl h go r ls lr ss Am J Kin y Di lmeuo ceo i? de s 19 934:18 9; 6 .

S o a gP n ei S n r m Nert Ak t a c I fk i te tk k s e rn e d rt id o a fi k u P s a n e s S rpo o u i Ni Made Renny A Rena, Ketut Suwitra

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