Professional Documents
Culture Documents
Pekerjaan
: Sudung O. Pardede
: Staf pengajar Divisi Nefrologi,
Departemen Ilmu Kesehatan Anak
FKUI-RSCM, Jakarta
Riwayat pendidikan:
1982
1992
2002
: dokter umum
: dokter spesialis anak
: dokter spesialis anak konsultan
1983
1984 1989
Riwayat pekerjaan:
1993 sekarang
1997
1999
1999
2002
2008
2011
2014
sekarang
2002
2008
2014
2014
2017
: FK UKI
: FKUI
: FKUI
Sudung O. Parde
Departemen I. K. Anak
Divisi Nefrologi
FKUI RSCM
Jakarta
Mean BP = CO X PR
Mean BP = mean blood pressure
CO
= cardiac output
PR
= peripheral resistance
Dipengaruhi:
Umur
Jenis kelamin
Berat badan
Tinggi badan
Aktivitas
Anak besar:
Posisi duduk, punggung ditopang/bersandar
Kaki menapak pada lantai
Anak kecil:
Berbaring
Menentukan hipertensi:
ukur tekanan darah 3 kali berturut-turut dalam
waktu berbeda
Neonatus
Bayi
Anak
Dewasa kecil
Dewasa
Dewasa
besar
Paha
Lebar
kantong
manset
(cm)
4
6
9
10
13
16
20
Panjang
kantong
manset
(cm)
Lingkar
lengan
maksimum
8
12
18
24
30
38
42
10
15
22
26
34
44
52
Note: Jenis manset tidak menjamin bahwa manset cocok untuk anak
sesuai dengan batasan umurnya
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and
Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Pediatrics 2004;114:555-76.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and
Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Pediatrics 2004;114:555-76.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and
Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Pediatrics 2004;114:555-76.
Hypertension:
average SBP/DBP > 95th percentile for age and sex on at least 3
occasions
Hypertension:
a. Significant hypertension: BP persistently between
95th and 99th percentiles for age and sex
b. Severe hypertension: BP persistently > 99th
percentile for age and sex
Task Force on Blood Pressure Control in Children. Report of the second task force on blood pressure control
in children 1987. Pediatrics 1987;79:1-25
Prehypertension:
average SBP/DBP: 90th - < 95th percentile for gender, age, and height
on > 3 occasions
Hypertension:
3
average SBP/DBP > 95th percentile for gender, age, and height on >
occasions
Hypertension:
SBP (mmHg)
Age
BP
Percentile of Height
(Year) Percentile 5th 10th 25th 50th 75th 90th 95th
12
DBP (mmHg)
Percentile of Height
5th 10th 25th 50th 75th 90th 95th
50th
61
61
61
62
63
64
64
90th
75
75
75
76
77
78
78
95th
79
79
79
80
81
82
82
99th
86
86
87
88
88
89
90
Hipertensi:
-Tekanan sistolik > 180 mmHg
-Tekanan diastolik > 120 mmHg
-Hipertensi (tensi < 180/120) dgn
ensefalopati, gagal jantung, retinopati
< 5 tahun:
Tensi > 50% dari batas normal
Tensi> 1 dari batas normal
Alatas H. Naskah simposium dan workshop sehari: Kegawatan pada penyakit ginjal anak. Makasar, 27-28 Mei, 2006,17-28.
Hipertensi emergensi
(kerusakan organ target: +)
Hipertensi urgensi
(kerusakan organ target:-)
Hipertensi ensefalopati
Gagal jantung kongestif
Edema paru
GnGA/PGK
Krisis adrenergik
Trauma kepala
Strok
Infark miokard
Dissecting aortic aneurysm
2. Renovaskular
3. Kardiovaskular
a. Koartatio aorta
b. Middle aortic syndrome
c. Sindrom Williams
d. Sindrom Turner
4. Kelainan endokrin
5. Penyebab lainnya
a.
Kelainan neurologik
Brewer ED. Pediatric Nephrology, 5th edition, Philadelphia, Lippincott Williams & Wilkins,.2004;p.1179-1197.
Age group
Newborn
- Renal artery thrombosis or embolus
- Renal vein thrombosis
- Congenital renal malformations
- Coarctation of the aorta
- Renal artery thrombosis
- Bronchopulmonary dysplasia
Infancy to 6 years
- Renal parenchymal diseases
- Renal artery stenosis
- Coarctation of the aorta
- Medications (corticosteroids, albuterol,
pseudoephedrine)
- Endocrine diseases
6 to 10 years - Renal parenchymal diseases
- Renal artery stenosis
- Essential hypertension
- Endocrine causes
Adolescence - Essential hypertension
- Renal parenchymal diseases
- Substance abuse (cocaine, amphetamines,
phencyclidine, methylphenidate, caffeine)
- Endocrine causes
Causes
Brewer ED. Pediatric Nephrology, 5th edition, Philadelphia, Lippincott Williams & Wilkins,.2004;p.1179-1197.
Obat anti-hipertensi
Investigasi penyebab
Diuretik
Alpha-adrenergic blocking agents
Beta blockers
Alpha- and beta-blocking agents
Central adrenergic agonists (central acting alpha
stimulators)
Peripheral vasodilators
Calcium channel blockers
Angiotensin converting enzyme inhibitors (ACE
inhibitors)
Angiotensin receptor blockers (ARB)
Drug of choice:
Short acting
dapat dititrasi
Na nitroprusid, labetalol, nikardipin, hidralazin,
diazoxide, klonidin, nifedipin, fenoldopam, esmolol,
enalaprilat
Indonesia:
Na nitroprussid, klonidin, nifedipin, nikardipin
Infus
Monitoring BP
Metabolit toksik: sianida, thiosianat
Central agonist
Sangat berguna jika tdk ada perawatan intensif
Efek samping:
- mulut kering
- penurunan kesadaran
- peningkatan enzim hepar
- nyeri otot dan sendi, dan rash.
Klonidin sulit memantau ensefalopati hipertensif
Rebound hypertension jika dihentikan medadak
Alatas H. Naskah simposium dan workshop sehari: Kegawatan pada penyakit ginjal anak, Makasar, 27-28 Mei, 2006,17-28.
Vogt BA, Davis ID. Pediatric Nephrology, 5th edition, Philadelphia, Lippincott Williams & Wilkins,.2004;p.1199-1220.
29
Efektif, aman
Vogt BA, Davis ID. Pediatric Nephrology, 5th edition, Philadelphia, Lippincott Williams &
Wilkins,.2004;p.1199-1220
Li SPS, Wong SN. Practical Paediatric Nephrology, 1st ed., Hong Kong, Medcom Limited, 2005;p.89-95
Alatas H. Naskah simposium dan workshop sehari: Kegawatan pada penyakit ginjal anak. Makasar,
27-28 Mei, 2006,17-28.
Vogt BA, Davis ID. Pediatric Nephrology, 5th edition, Philadelphia, Lippincott Williams &
Wilkins,.2004;p.1199-1220
DIASTOLIK
90 100 mmHg
STABIL
NIFEDIPIN RUMAT
0.2 mg 1 mg/kgbb/hari,3-4 x
32
- penyebab
- ko-morbiditas
- kerusakan organ target
Evaluasi bersifat individu
Penyebab utama: renoparenkim atau
renovaskular
skrining keadaan ini
Evaluasi:
Ekokardiografi
Sel LE, ANA, anti-dsDNA
T3, T4, TSH serum
Kateholamin urin,
Aldosteron plasma, aktivitas renin plasma
MSU, CT scan, MRI
Skintigrafi DMSA, DTPA, USG Dopler
Arteriografi ginjal
Biopsi ginjal
Mauliate atau Te