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2. "presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis." what does the
symptoms suggest to you?
Uremia: Symptoms of uremia are are non-specific. You have to keep this possibility in mind whenever there is consideration
for renal disease.
Lethargy
Nausea and vomiting
Fatigue
Lethargy
Pruritus
7. Why was a renal ultrasound ordered? What information can you gather from renal ultrasound studies?
To determine kidney :
Size
Echogenicity
Rule out obstruction
8. How does the results of the renal ultrasound influence your thinking on the diagnosis? What is the normal size of the
kidney? Is his kidney size normal? What does small or large kidney signify?
Size:
Normal
Large: Consider
Small: Consider (mengecil karena fibrosis N: 11 cm x 7 cm x 5 cm)
9. What is the significance of the report "Both kidneys illustrate hyperechogenicity" How does evaluation of
echogenicity help in the diagnosis?
Echogenicity. (Normal Korteks: hypoecoic, Pelvis: hyperecoic, Echogenicity dapat menentukan akut/ atau khronik )
11. Is the cause of this patients renal failure acute or chronic? How did you arrive at that conclusion?
Chronic
Acute : Short duration and rapid rise of BUN and creatinine.
Chronic : Long duration of BUN and creatinine elevation, Hemoglobin is low, Calcium and Parathormone disturbance
13. What would be the calculated GFR in this case if the patient was female?
(140- age) x BB (kg) x 0,85 (140- 41) x 76,5 x 0,85
GFR= GFR (male) x 0,85 = 72x creatinine serum = 72x 16 = 5,588 ml/min ~ 5,6 ml/min
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14. What are the modalities treatment for the patient? Please explain the advantages and disadvantages of each
modality?
Renal transplantation
+) Tidak dialysis, restriksi diet menurun, pasien merasa lebih sehat
-) Waktu tunggu lama (untuk donor yang meninggal), kemungkinan graft rejection, resiko saat operasi, butuh obat setiap
hari (steroid cushing syndrome), rawan infeksi.
Hemodialisis
+) Terapi dilakukan oleh tenaga keshatan, tidak dilakukan setiap hari (3x/minggu), tidak membutuhkan alat di rumah
-) Membutuhkan asisten kesehatan untuk memasukkan alat, ke rumah sakit 3x seminggu pada jadwal ketat, retriksi cairan
dna diet, resiko infeksi, kemungkinan ketidaknyamanan (pusing, mual, keram kaki)
Perytoneal dialysis
+) Terapi dialysis berlangsung terus (tidak berkala), terapi berkelanjutan dapat disesuaikan dengan gaya hidup terapi dan
dapat dilakukan saat sedang tidur
-) Harus ke rumah sakit setiap hari untuk mengganti alat, resiko infeksi, kateter permanen, butuh alat di rumah.