1. Dr. Ginova Nainggolan, SpPD-KGH
Instansi :
Divisi Ginjal Hipertensi
Departemen Ilmu Penyakit Dalam
FK UI/RSCM Jakarta
  Pendidikan :
Dokter : FK UI, 1985
Spesialis Penyakit Dalam : FK UI, 1996
Konsultan Ginjal Hipertensi : PAPDI, 2003
   Organisasi :
 IDI : Anggota
PAPDI : Anggota
PERNEFRI : Sekretaris Umum
ISN : Anggota

2. Hipertensi Pada Kelainan Ginjal
Dr.Ginova Nainggolan
Divisi Ginjal Hipertensi
Departemen Penyakit Dalam
RSCM/FKUI

3. Telur ayam
Hipertensi kelainan ginjal
Kelainan ginjal hipertensi

5. Prevalence in Indonesia
31,7 % in Indonesian population has hypertension
14,9% of population in Kepulauan Riau province has stroke
Management of hypertension is important skilll for Indonesian physician.
RISKESDAR 2007

6. Hypertension Awareness, Treatment and Control
NOTES: Due to rounding, detail may not sum to total.
Hypertension as a public health risk.
Data: Canadian Heart Health Survey (CHHS)(Statistics Canada); Canadian Health Measures Survey (CHMS)(Statistics Canada); Ontario Survey on the Prevention and Control of Hypertension.
Years: Varies
Type: Measured data, weighted to represent the Canadian population
Ages: Varies
Joffres MR, Hamet P, MacLean DR, L’italien GJ, Fodor G. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001;14(11):
Leenen FHH, Dumais J, McInnis NH, Turton P, Stratychuk L, Nemeth K, Lum-Kwong MM, Fodor G. Results of the Ontario Survey on the Prevalence and Control of Hypertension. CMAJ. 2008;178(11):
Wilkins K, Campbell NRC, Joffres MR, McAlister FA, Nichol M, Quach S, Johansen HL, Tremblay MS. Blood pressure in Canadian adults. Health Reports. 2010;21(1):37-46.
Statistics Canada. Blood pressure of Canadian adults, 2009 to Ottawa, ON: Statistics Canada,

7. Complications of Hypertension: End-Organ Damage
Peripheral
Vascular
Disease
Renal Failure,
Proteinuria
LVH, CHD, CHF
Hemorrhage,
Stroke
Retinopathy
Hypertension
Risk Factors
Complications of Hypertension: End-Organ Damage
Hypertension is an important contributing risk factor for end-organ damage and for the development of cardiovascular and other diseases, including retinopathy, peripheral vascular disease, stroke, coronary heart disease, heart failure, cardiac disease, renal failure, and proteinuria.
Blood pressure reduction has been shown to decrease the rate of stroke, myocardial infarction, end-stage renal disease, and proteinuria.
Reference:
Chobanian AV, Bakris GL, Black HR, et al, for the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:
CHD = coronary heart disease
CHF = congestive heart failure
LVH = left ventricular hypertrophy
Slide Source
Hypertension Online
Chobanian AV, et al. JAMA. 2003;289: 7 7

8. Incident Rates by Primary Diagnosis (per million population, adjusted)
Dialysis
Diabetes is the most rapidly rising cause of ESRD, but the hypertension rate also continues to rise.
USRDS, 2003

10. The incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%.
factors associated were
older age (odds ratio [OR] 1.123, 95% confidence interval [CI] ), presence of diabetes (OR 2.621, 95% CI ), lower baseline eGFR (OR 1.041, 95% CI ) and baseline hyperuricaemia (OR 1.004, 95% CI ).

13. Mechanism failure of autoregulation glomerular in hypertension
Systolic BP :
175 mmHg
MAP
PGc N/<
PGc >>
inflammation
Kidney International, Vol. 64 (2003), pp. 1923–1932

14. Systemic hypertension
Primary Renal Disease
Renal Ablation
Aging
Diabetes Mellitus
Dietary Factors
GLOMERULAR HYPERTENSION
Endothelial injury
Relase of vasoactive factors
Vascular lipid deposition
Intracapillarry thrombosis
Mesangial injury
Accumulation of macromolecules
 Matrix production
 Cell proliferation
Epithelial injury
Proteinuria
 Permeability of water
SKLEROSIS GLOMERULAR
FIGURE 2. Pivotal role in glomerular hypertension in the initiation and progression of structural injury
Kaplan 2010, Clinical Hypertension

18. Medication Use and BP Control in ALLHAT %
This slide shows the percentages of ALLHAT participants who achieved the goal BP (green line for Canada, yellow for the USA) <140/90 mm Hg among those attending follow-up visits. The proportion of patients who were prescribed 1, 2, or 3 drugs to achieve goal BP are shown. The number of patients requiring multiple drugs increased every year during the study. By the end of the study, 63% of patients were on 2 or more antihypertensive agents. Patients included in the study were aged 55 and above who had stage 1 or 2 hypertension with at least 1 additional risk factor for CHD events.
Reference:
Cushman WC, Ford CE, Cutler JA, et al, for the ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2002;4:
<140/90 mm Hg
Cushman et al. J Clin Hypertens 2002;4: 18

26. Kesimpulan Pengendalian tekanan darah penting mencegah penyakit ginjal
Pada penyakit ginjal pengendalian tekanan darah penting mencegah perburukan fungsi ginjal

27. THANK YOU