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Nephrolitiasis

Kidney Stones
 Nephrolithiasis =
“Kidney Stones”
 Batu ginjal adalah massa
kristal padat yang
dibentuk di ginjal dan
melalui jalur kantung
kemih (Urinary Text)

Diniyah Kholidah
Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

Batu Ginjal Nephrolithiasis


Batu berkembang dalam ginjal.
 Batu ginjal berbentuk kecil dan keras, tersusun Klasifikasi batu : oxalate, uric acid, cystine,
atas mineral dan garam. calcium phosphate, and magnesium
 Nama lain : ammonium phosphate (struvite).
 Renal Lithiasis

 Renal Calculi

 Nephrolithiasis (Kidney Stone Disease)

 Jenis batu diklasifikasikan berdasarkan pada


lokasi batu dalam sistem kemih dan komposisi
kristal batu.
Chapter 19 Copyright © 2003 Delmar Learning, a Thomson 4
Learning company

Prevalence Statistics
 Nephrolithiasis affects over 5% of adults in
the United States  Incidence Rate:
 12% men  More than 1 million cases annually in US
 6% women  1 in 272 or 3.6 per 1000 Americans develop
stones annually.
 50% of patients will have additional stones
 80% of stones under 2mm in size
 90% of stones pass through the urinary
system spontaneously
 Generally stone smaller than 6mm are passable
(National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK)
(National Kidney and Urologic Disease Information Clearinghouse; NKUDIC)
Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

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Formasi Batu Ginjal Signs and Symptoms
 Disebabkan :  Hematuria
 Tingginya konsentrasi urin, urine stasis  Mual dan muntah
 Ketidakseimbangan pH urin
 Asam : Uric and Crystine Stones
 Terasa sakit saat
 Basa : Calcium Stones
BAK
 Gout  Sakit dibawah ulu hati
 Hyperparathyroidism
 Inflammatory Bowel Disease
 UTI
 Medications
 Lasix, Topamax, Crixivan
http://www.pilotfriend.com/aeromed/medical/images2/25.jpg

Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

Signs and Symptoms Types of Stones


 Additional S/S:
 What are the key findings?  Calcium Oxalate
 Presence of UTI
 Severe flank pain
 Fever or Chills  Paling sering
 Abdominal pain
 Pain in groin, labia or testicles
 Nausea and vomiting  Calcium Phosphate
 Cloudy or foul-smelling urine
 Fatigue  Struvite
 Dysuria
 Elevated temperature, BP, and
 Persistent urge to void  Insiden terbesar pada wanita dibandingkan pria.
respirations
 UA positive for RBC  Berhubungan dengan UTI.
 Objective Data: perspiration,
clutching of the abdomen,
 Uric Acid
doubled-over.  Disebabkan karena diet tinggi protein dan purin.
 Steady Pain
 Cystine
 Left flank tendernes
 Jarang, berhubungan dengan penyakit bawaan
http://knol.google.com/k/-/-/27ifsyywko3wx/sqc1f9/kidneystonesymptoms.jpg

Assessment Information Risk Factors


 Increased BMI
 Family history
 Increased waist circumference
 Current medications
 Genetics
 Frequency of urination
 Hypertension
 Do you experience pain while urinating?
 Hypercalciuria
 What is your typical diet?
 Vitamin C
 Diarrheal state

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.
http://erstories.net/wp-content/uploads/2008/10/kidneystone1a.jpg Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600-
603.

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Risk Factors Abnormal Lab Values
 Urinary Tract Infection
 Catheterization
BUN
 Bowel Disease
 Environmental Creatinine
Factors:
 Heat exposure Urine Analysis
 Employment
 Exercise

https://www.clevelandclinic.org/heartcenter/images/guide/tests/lab.gif
http://www.ganfyd.org/images/f/fb/Dipstick_bottle.jpg

Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.

Diagnostic Studies Surgical Procedures


 Test and Diagnostics:  Lithotripsy: used to break into smaller fragments
 Blood Analysis allowing it to pass through the urinary tract.
 Extracorporeal Shock-Wave (ESWL)
 Urine Analysis
 Percutaneous Ultrasonic
 CT Scan  Electrohydraulic
 Abdominal x-ray  Laser
 Ultrasound
 Surgical Therapy
 Retrograde Pyelogram  Nephrolithotomy (Kidney)
 Cystoscopy  Pyelolithotomy (Renal Pelvis)
 Intravenous pyelography (IVP)  Ureterolithotomy (Ureter)
http://knol.google.com/k/-/-/PYwIQr_i/GXb8Fg/Stone%20CT.jpg
 Basket Extraction
http://www.svhm.org.au/Department_Index/Lithotripsy/images/Kidney-Stones.gif

Pencegahan Calcium Oxalate Stones


 Edukasi  Rendah kalsium, mengurangi
 Hidrasi resiko batu Ca Oxalate
 Minum 3 liter air/hari (14 gelas)
In fact, higher dietary calcium
 Air minum mineral
intake may decrease the
 Lemonade (sitrat mengurangi pembentukan batu)
 Diet incidence of renal stones for
 Rendah garam most people.
 Batasi oxalate  Memilih bahan makanan rendah
 Rendah protein oksalat (beets, wheat bran,
 Aktifitas fisik chocolate, tea, strawberries,
 Obat-obatan spinach).

Chapter 19 Copyright © 2003 Delmar Learning, a Thomson 18


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http://3.bp.blogspot.com/_-gcaht5yp_0/SdINrCVuqdI/AAAAAAAAAGw/xeEk4-F3z_I/s320/foods+rich+in+oxalate+2.gif

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Uric Acid Stones Cystine Stones
 Rendah purin.
Purines are the end products of nucleoprotein
metabolism.
Cystine adalah salah satu asam amino.
 Ditemukan dalam ikan, daging, unggas,
Batu Cystine dibentuk dari batu konsentrasi
ikan, jerohan, teri, sardines, kaldu
tinggi ok. Kelebihan urin dalam sal. Kemih.
 Berhubungan dengan penyakit Gout,
Meningkatkan cairan dan menganjurkan diet
penyakit GIT karena diare, pnyakit
sisa basa.
malignant diease.

Chapter 19 Copyright © 2003 Delmar Learning, a Thomson 19 Copyright © 2003 Delmar Learning, a Thomson 20
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Struvite Stones Medical Nutrition Therapy


 Tujuan diet untuk Nephrolithiasis :
Tersusun atas of magnesium ammonium
mencegah terbentuknya batu baru dan
phosphate.
mencegah perkembangan batu
Kadang disebut infeksi batu karena berangkat
dari (UTI urinary tract infections).
Diet rendah P.

Chapter 19 Copyright © 2003 Delmar Learning, a Thomson 21 Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Learning company Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600-
603.

Medical Nutrition Therapy Medical Nutrition Therapy


 Decrease sodium to 100 mmol/day  Increase calcium intake to 1000 -1200 mg/day
 To prevent Calcium containing stones ***
 Decrease excessive animal protein  Increase fluids with at least 50% WATER
 To prevent Uric acid and calcium stones
 2.5-3 L/day
 > 1 g/kg should be avoided
 Urine volume should be 2 L/day
 Recommendation 1 g/kg
 .6 g/kg for diabetic patients  < 50 mg/day dietary oxalate
 To prevent Calcium Oxalate stones
 Increase fruits and vegetables
Avoid grapefruit juice, beets, cola,
chocolate, coffee, tea, berries,  Increase insoluble fiber
spinach, and rhubarb  Weight loss
 Low fat, low calorie
Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.
Vergili, Joyce M. (2009). Diabetic Kidney Diesase: What RDs need to know. Today’s Dietitian, 11, 8-48. Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.
Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database. Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29.

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General Dietary Principles:
Kidney Stones Mosby items and derived items ©
2006 by Mosby, Inc. Diet Sisa Asam
 Meningkatkan keasaman urin (dengan
menggunakan chloride, phosphorus, and
sulfur)
 Ditekankan pada golongan daging, keju dan
serealia
 Membatasi sayur dan buah (kecuali jagung,
kacang-kacangan,, cranberries, plums,
prunes)

Slide 25

Diet Sisa Basa


 Meningkatkan ph Basa urin (berisi sodium,
potassium, calcium, and magnesium)
 Ditekankan pada golongan sayur dan buah
(kecuali jagung, lentils, cranberries, plums,
prunes)
 Membatasi garam dan serealia