SINDROM NEFROTIK

Lestari Sukmarini, MN
KMB FIK-UI
2009
tanggal upload : 29 April 2009

SINDROM NEFROTIK
PENERTI!N
meru"akan sa#a$ satu %am&aran k#inik
"en'akit %#(meru#us 'an% )i tan)ai
)en%an "r(tenuria masi* +,,- %ram . 2/
0am . 1,2, m2 )isertai $i"(a#&uminemia,
e)ema anasarka, $i"er#i"i)emia,
#i"i)uria,)an $i"erk(a%u#a&i#itas3


4 DI!NOSIS
4 !namnesis 5 &en%kak se#uru$ tu&u$,&uan% air ke6i# keru$
4 Pemeriksaan *isis5 e)ema anasarka,asites
4 La&(rat(rium5Pr(teinuria masi* +,,- %ram . 2/ 0am .
1,2, m2, $i"er#i"i)emia,$i"(a#&uminemia 7 8,,- %ram
.)#9,#i"i)uria,$i"erk(a%u#a&i#itas3
4 Dia%n(sis eti(#(%i &er)asarkan &i("si %in0a#
4 DI!NOSIS B!NDIN
E)ema )an asites aki&at "en'akit $ati atau
ma#nutrisi,)ia%n(sis


Patogenesis edema pd SN
Proteinuria
albumin plasma
Tekanan osmotik koloid plasma
Pergeseran cairan
ekstrasel
Cairan
interstisiel
Edema
Cairan
ekstrasel
Cairan
intravaskular
Renin-angiotensin
Aldosteron
Reabsorbsi Na
pd tubulus
Retensi Na &
H2O

IN:ESTI!SI
4 URIN!LIS!
; Pr(teinuria
; Di"sti6k test
; 2/-$(ur <uantitati=e test
4 !na#isa )ara$
; !#&umin 8 23- %r.)L
; Li"i)5 LDL.:LDL > ?DL
; BUN.@reatinine
4 Bi("si %in0a#
4 Ima%in% stu)ies5 rena# US


Pr(teinuria
Pr(teinuria
4 Di"sti6k test5
; ne%ati=e, tra6e
; 1A 76#(sest t( ,0 m%.)L9
; 2A 76#(sest t( 100 m%.)L9
; ,A 76#(sest t( ,00 m%.)L9
; /A 7%reater t$an 2,000 m%.)L9

Pr(teinuria
Pr(teinuria
4 N(rma# ran%e
100m%.m
2
.)a' 71-0m%.)a'9,
8/ m%. m
2
.$(ur
4 Ne"$r(ti6 ran%e
+ 1 %m. m
2
.)a'
+/0m% . m
2
.$(ur
4 S"(t urine *(r a#&umin.6reatinine rati(
7m%5m%9
; N(rma# B 8032 703- i* 82'r9
; Ne"$r(ti6 B+ 2

In)ikasi &i("si %in0a#
4 Pr(teinuria + 1%r.$ari
4 ?ematuria A
4 ?i"ertensi A
4 Fun%si %in0a#

Eti(#(%i NS
4 Pen'akit %in0a# "rimer 72--C0D9
4 Pen'akit sekun)er

Ort ! and Rit" E# N Engl $ %ed &''()**(+&2,2-&2&&
Relative -re.uenc/ o0 Primar/ 1lomerular 2iseases 3nderl/ing te Neprotic !/ndrome in
Cildren and Adults

4 #(meru#("at$' #esi minima#
; Faa# %in0a# n(rma#, res"(n k(rtik(ster(i) A
remisi 90D
; Remisi s"(ntan E0D
4 #(meru#("at$' #esi mem&ran(sa
; Faa# %in0a# 8, remisi ,0D,serin% re#a"s @KD
4 #(meru#(sk#er(sis *(ka#
; Pr(teinuria masi*, remisi 2-D
4 #(meru#("at$' #esi "r(#i*erati*
; Re#ati* 0aran%
; ?ematuria A, $i"ertensi, K(rtik(ster(i)F

Ort ! and Rit" E# N Engl $ %ed &''()**(+&2,2-&2&&
Rare Causes o0 te Neprotic !/ndrome

Ort ! and Rit" E# N Engl $ %ed &''()**(+&2,2-&2&&
%a4or -actors Contributing to te H/percoagulable !tate in te Neprotic !/ndrome

S'm"t(ms
4 Edema: swollen face,
ascites, pleual
effusion, swollen
genital!
4 Oliguia
4 "ematuia
4 anoe#ia, fatigue,
iita$le, pale
4 Diae
4 Respiato% distess
4 "ipetensi
4 Infe&si
4 Tom$oem$oli


Treatment
4 tera"i s"esi*ik untuk ke#ainan )asar %in0a#
atau "en'akit
"en'e&a& 7"a)a SN sekun)er9,
4 men%uran%i atau men%$i#an%kan
"r(teinuria,
4 mem"er&aiki $i"(a#&uminemi
4 men6e%a$ )an men%atasi "en'u#it3

Patofisiologi Pengo$atan
Keusa&an glomeulus Imunosupesif: m%cop'enolate mofetil
(MMF), si&lospoin
*nti&oagulan:'epain+wafain
*nti agegasi tom$osit: aspiin
Ke'ilangan potein Diit ,- &al+&g..+' RP /!012
g+&g..+' atau /!3 g+&g..+' 4
gam poteinuin
"ipoal$uminemia dan penuunan
te&anan on&oti&
Infus al$umin (2-5) ,// ml+6- mnt
Se&esi aldosteon Diueti& spionola&ton
Retensi natium dan ai Diueti& fuosemid 6/ mg+'
Diit enda' gaam 217 g+'ai
Sem$a$ %ang esisten ultafiltasi
Kontol infe&si anti$ioti&
Kolesteol daa' 'ido#%met'%l gluta%l co1en8%me *
("M9 :o1*) eductase

4 K(ntr(# $i"ertensi an%i(tensin
6(n=ertin% enG'me 7!@E-19 in$i&it(rs )an
!n%i(tensin Re6e"t(r anta%(nist

sirku#asi, tekanan )ara$, tekanan
%#(meru#us

ke&(6(ran "r(tein, mem"er#am&at
H"r(%ressi=e s6arrin%I %#(meru#i3
4 N(n *armak(#(%i #ain5 &e)rest, )iet ren)a$
k(#ester(#

:omplications
4 at$er(s6#er(sis J$ar)enin% (* t$e
arteriesH
4 a)=erse rea6ti(n t( ster(i)s an)
immunisu""ressant5 (ste("(r(sis, 6atara6t
)e=e#("ment, in6rease) risk (* in*e6ti(n,
an) )ia&etes3
4 Ki)ne' *un6ti(n5 insu**i6ien6' @KD
4 r(Kt$ De#a's in 6$i#)ren
4 In*e6ti(n

Pognosis
4 Umur L %en)er5 anak, Kanita + &aik3
4 k(m"#ikasi,
4 ti"e $ist("at(#(%is %in0a#
4 Kematian5 K, in*eksi sekun)er,
%a%a# sirku#asi3

PEN9K*;I*N KEPER*<*T*N
Riwa%at &ese'atan 5 ISP!, in*eksi ku#it, in*eksi sa#uran kemi$,
$e"atitis, (&at ne*r(t(ksik, riKa'at ke#uar%a )en%an "en'akit
"(#ikistik, ke%anasan, ne*ritis $ere)iter3
Si&ulasi 5 $i"ertensi, )isritmia kar)ia, )istensi =ena 0u%u#ar, e)ema
%enera# 7termasuk area "eri(r&ita#, sakrum9, "a##(r3
Eliminasi 5 "eru&a$an "(#a urin, "eru&a$an Karna urin se"erti mera$,
keru$, "ekat, (#i%uri3
Ma&anan+caian 5 "enam&a$an &erat &a)an 7e)ema9, )e$i)rasi, mua#,
munta$, a)an'a "en%%unaan )iuretik, "eru&a$an tur%(r ku#it, e)ema3
N%ei 5 "a)a area k(st(=erte&ra#."in%%an%
Penafasan 5 )is"nea, taki"nea, a)an'a &atuk "r()ukti* 7e)ema "aru9
Pemei&saan diagnosti& :
Pemeriksaan se)imen urin 5 urin 2/ 0am untuk "emeriksaan &ersi$an
kreatinin )an "r(tein t(ta# untuk mem"er$itun%kan *un%si %in0a#
resi)ua# )an ekskresi "r(tein urin3 6ast se# )ara$ mera$ mem&antu
men%ara$kan &a$Ka $ematuria )ari %#(meru#us3
.iopsi gin=al ke#ainan $ist(#(%i 'an% ter0a)i3
Daa' 5 ?& menurun karena anemia, BUN-6reatinin menin%kat, "r(tein
a#&umin serum menurun3

Pemeriksaan #ain 'an% "entin% a)a#a$ 5 ureum serum,
a#&umin, k(#ester(#, e#ektr(#it )an 0u%a
"emeriksaan ser(#(%is se"erti5 aut(anti&()i,
6(m"#ement @, @/, imun(%#(&u#in3
>in5 0um#a$ urin 8/00 66.2/0am> Karna urin mera$
)itemukan a)an'a $ematuria %r(ss.mikr(sk("ik,
"r(teinuria 7ren)a$ 1-2A> tin%%i ,-/A9, Bersi$an
6reatinin mun%kin menurun3
Radiogafi+>S95 "em&esaran.men%e6i# %in0a#> &atu.
(&struksi3

Nursin% )ia%n(sis
4 a#terati(n in *#ui) =(#ume5 eM6ess>
4 risk *(r in*e6ti(n>
4 a#terati(n in nutriti(n5 #ess t$an &()'
re<uirements,
4 "(tentia# a#terati(n in 6(m*(rt>
4 kn(K#e)%e )e*i6it> an)
4 "(tentia# )istur&an6e in se#*-6(n6e"t5 &()'
ima%e3

N>RSIN9
M*N*9EMENT
4 M(nit(r I L ON"(ssi&#' #imit *#ui)s &a#an6e 7-9
4 Oei%$ )ai#'Ne=a#uatin% am(unt (* e)ema, a&)(mina# 6ir6u*eren6e
4 Makin% "atient 6(m*(rta&#e
4 Maintainin% %(() nutriti(n
4 DietN?i%$ "r(tein, $i%$ @?O *(r "r(tein s"arin%, #(K *at, sa#t
restri6ti(ns
4 Pre=entin% in*e6ti(ns5 uni=ersa# "re6auti(ns, #imit in=asi=e
"r(6e)ure,
4 Be)rest
4 !6ti=it' ma' in6rease as e)ema )e6reases
4 Measures t( "re=ent skin &reak)(Kn3
4 M(nit(r #a&
4 M(nit(r si)e e**e6t (* me)i6ati(ns

?ifest%le and 'ome
emedies
4 Limit sa#t intake t( $e#" minimiGe *#ui)
retenti(n an) sKe##in% an) t( re)u6e &#(()
"ressure
4 M()i*' )iet t( )e6rease 6$(#ester(# an)
tri%#'6eri)e #e=e#s
4 Take =itamin D su""#ements
4 Re"(rt si%ns (* re#a"s
4 In*e6ti(n "re=enti(n
4 @$e6k re%u#ar#' t( )(6t(r (r )ietitian

Diet

Refeences:
4 B#a6k, PM3 L Matassarin-Pa6(&s, E3 7199293 Me)i6a# sur%i6a#
nursin%5 @#ini6a# mana%ement *(r 6(ntinuit' (* 6are3 7-
t$

e)393OB Saun)ers @(m"an', P$i#a)e#"$ia3
4 (#)man, L3 L Bennett, P@3 7200193 P(6ket 6(m"ani(n t( 6e6i#
teMt&((k (* me)i6ine 721
st
e)393 OB Saun)ers @(m"an',
P$i#a)e#"$ia3
4 Ree=es, @P3, R(uM, 3, L(6$art, R3 7200193 Ke"eraKatan
me)ika# &e)a$ 7E)3 Set'(n(, P393 Pener&it Sa#em&a Me)ika,
Pakarta3
4 Sukan)ar, E3 7199293 Ne*r(#(%i k#inik3 72
n)
e)393 Pener&it ITB,
Ban)un%3
4 Oi#s(n, DD3 7199C93 Nurses %ui)e t( un)erstan)in%
#a&(rat(r' an) )ia%n(sti6 test3 Li""in6(tt Oi##iamLOi#kins,
P$i#a)e#"$ia3
4
$tt"5..
KKK3ne"$r(#(%'6$anne#36(m.ne"$r(ti6.)ia%n(sis3s$tm#
4 $tt"5..ne"$r(ti6s'n)r(me36(m

THANK YOU ..