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Remaja perempuan dengan hipertensi sekunder dan chronic kidney disease (CKD) on hemodialisis akibat sindrom nefrotik: sebuah laporan kasus

Abstract

Background: Hypertension is a major risk factor for cardiovascular disease. The predominant type of hypertension in adolescents is secondary hypertension. Renal parenchymal disease is responsible for secondary hypertension in 3-5% of people diagnosed with hypertension. One of the kidney diseases that can cause hypertension is nephrotic syndrome. This disease is characterized by proteinuria, hypoalbuminemia, oedema and hyperlipidaemia. Progressive nephrotic syndrome can lead to Chronic Kidney Disease (CKD), which continues to become end-stage kidney disease. In this condition, the patient will need special therapy including haemodialysis or kidney transplant.

Case description: An 18-year-old young woman came with complaints of sudden headaches, accompanied by swelling of both legs. Physical examination revealed blood pressure of 200/115 mmHg, anaemic conjunctiva and oedema of both legs. Laboratory investigations revealed haemoglobin 7.4 gr/dL, urea 228 mg/dL, creatinine 9.5 mg/dL, and albumin 2.2 gr/dL. Total cholesterol results were 300 mg/dL. From urine examination found proteinuria 2+ and 24 hours urine showed protein level of 5 grams/day. Electrolyte examination obtained potassium 6.3 mmol/L. The patient was diagnosed with stage V CKD presumably due to nephrotic syndrome with emergency hypertension, moderate anaemia, hypoalbuminemia and hyperkalaemia. During hospitalization the patient was given supportive therapy and special therapy with haemodialysis.

Conclusion: The pathophysiology of hypertension in cases of nephrotic syndrome is very complex, with many contributing factors. While the pathophysiology of CKD in patients with nephrotic syndrome has not been found certainty. Acute Kidney Injury is an independent risk factor that causes nephrotic syndrome develop into CKD.

 

Pendahuluan: Hipertensi merupakan faktor risiko utama penyakit kardiovaskular. Jenis hipertensi yang dominan pada anak remaja adalah hipertensi sekunder. Penyakit parenkim ginjal bertanggung jawab atas hipertensi sekunder pada 3-5% orang yang didiagnosis hipertensi. Salah satu penyakit ginjal yang dapat menimbulkan hipertensi adalah sindrom nefrotik. Penyakit ini ditandai dengan proteinuria, hipoalbuminemia, edema dan hiperlipidemia. Sindrom nefrotik yang terus mengalami progresivitas dapat menyebabkan Chronic Kidney Disease (CKD) yang berlanjut menjadi penyakit ginjal stadium akhir. Pada Kondisi ini, pasien akan memerlukan terapi penggantian ginjal dengan hemodialisis atau transplantasi ginjal.

Laporan kasus: Wanita muda usia 18 tahun dengan keluhan nyeri kepala yang dirasakan secara tiba-tiba, disertai dengan pembengkakan pada kedua kaki. Pemeriksaan fisik didapatkan tekanan darah 200/115 mmHg, dengan konjungtiva anemis dan edema pada kedua tungkai. Pemeriksaan laboratorium didapatkan hemoglobin 7,4 gr/dL, ureum 228 mg/dL, kreatinin 9,5 mg/dL, serta albumin 2,2 gr/dL. Hasil kolestrol total 300 mg/dL. Dari pemeriksaan urin ditemukan proteinuria 2+ dan urin 24 jam menunjukkan kadar protein 5 gram/hari. Pemeriksaan elektrolit didapatkan kalium 6,3 mmol/L. Pasien didiagnosis dengan CKD stadium V yang diduga karena sindrom nefrotik dengan hipertensi emergency, anemia sedang, hipoalbumin dan hiperkalemia. Selama perawatan pasien diberikan terapi suportif dan dilakukan terapi khusus berupa hemodialisis.

Kesimpulan: Patofisiologi hipertensi pada kasus sindrom nefrotik sangat kompleks, dengan banyak faktor kontributor. Sedangkan patofisiologi terjadinya CKD pada pasien dengan sindrom nefrotik belum ditemukan secara pasti. Acute Kidney Injury merupakan faktor risiko independen yang menyebabkan sindrom nefrotik berkembang menjadi CKD.

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How to Cite

Wirayanti Puteri, M. W., & Armansyah, F. . (2024). Remaja perempuan dengan hipertensi sekunder dan chronic kidney disease (CKD) on hemodialisis akibat sindrom nefrotik: sebuah laporan kasus. Intisari Sains Medis, 15(1), 55–63. https://doi.org/10.15562/ism.v15i1.1797

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Made Widya Wirayanti Puteri
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Fajar Armansyah
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