Nephrologi
Batasan: ilmu yg mempelajari fungsi dan
patofisiologi ginjal dan saluran2 penunjangnya
serta penyakit2nya.
Dasar2 yg perlu:
1. Anatomi & histologi
2. Fisiologi & biokimia
3. Patologi & laborat.
Introduction:
Kidney Anatomy:
Kidney Anatomy:
Introduction
Functions of the kidney:
excretion of waste products
regulation of water/salt
maintenance of acid/base balance
secretion of hormones
Glomerulonephritis
Tubular diseases: Acute tubular
necrosis
Interstitial diseases: Pyelonephritis
Diseases involving blood vessels:
Nephrosclerosis
Cystic diseases
Pendekatan klinis:
1.
2.
3.
4.
Anamnesis
Pemeriksaan fisik
Laboratorium
Pem. Penunjang:
a. radiologis: - BOF
- IVP
- CT Scan
- MRI
b. biopsi ginjal.
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Pemeriksaan fisik:
inspeksi
auskultasi
perkusi
palpasi
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Pem.laboratorium:
1.Urinalisis: - pH, BJ, warna
- albumin
- reduksi
- bilirubin/urobilin
- sedimen: eri,leko,
kristal,silinder
epitel.
2. Kimia darah: kreatinin plasma
klirens kreatinin
konsentrasi ureum plasma.
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Abnormal findings
Azotemia: BUN, creatinine
Uremia: azotemia + more problems
Acute renal failure: oliguria
Chronic renal failure: prolonged uremia
Clinical Syndromes:
Nephritic syndrome.
Oliguria, Haematuria, Proteinuria, Oedema.
Nephrotic syndrome.
Gross proteinuria, hyperlipidemia,
weeks
Nephrotic syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia/-uria
Nephritic syndrome
Hematuria
Oliguria
Azotemia
Hypertension
Glomerulopathy
Proses inflamasi glomerulus
Terjadi akibat berbagai sebab yg
Klasifikasi
glomerulopathy
1. Klasifikasi klinis
2. Klasifikasi lesi histopatologi
3. Klasifikasi berdasar
etiologi&patogenesis
4. Klasifikasi berdasar proses imunologi
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Klasifikasi klinis:
1.
2.
3.
4.
5.
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Klasifikasi lesi
histopatologis
a.
b.
c.
d.
e.
f.
g.
h.
i.
Lesi minimal
Lesi glomerulosklerosis fokal segmental
Lesi mesangioproliferatif (IgM)
Lesi mesangioproliferatif (IgA)
(penyakit Berger)
Lesi proliferatif akut
Lesi membranoproliferatif
Lesi membranosa
Lesi bulan sabit (crescentic)
Lesi glomerulosklerosis.
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Klasif. Etiologi&
patogenesa
a. Kelainan imunologi
b. Kelainan metabolik:
c.
d.
e.
f.
- nefropati diabettik
- nefropati as. Urat
- amiloidosis primer/sekunder
Kelainan vaskuler
Disseminated Intravascular Coagulopathy
(DIC)
Kel. Herediter: sindr.Alport, peny.Fabry
Patogenesis tak diketahui: lipoid nefrosis
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Klasifikasi. imunologi
a. Peny. Kompleks immun:
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Minimal change
disease
Normal glomerulus
Focal Segmental
Glomerulosclerosis
Primary or secondary
Some (focal) glomeruli show
Membranous
Glomerulonephritis
Autoimmune reaction against unknown
renal antigen
Immune complexes
Thickened GBM
Subepithelial deposits
Membranous glomerulonephritis
Post-infectious
glomerulonephritis
IgA Nephropathy
Common!
Child with hematuria after (URI)
IgA nephropathy
Sindroma nefrotik
Batasan: sindroma klinik ok.berbagai penyakit
yg ditandai dg meningkatnya
perm.membran basal glomerulus thd protein
dg.G/ utama proteinuri > 3,5 gram/24 jam.
Patofisiologi:
meningkatnya perm.GBM proteinuri
Bila loss albumin>
produksihipoalbuminemi
Hipoalbumin edema anasarka
Hiperlipidemia : patogenesanya belum jelas
Ggn. Metab.lemaklipiduria: oval Fat Bodies
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Etiologi:
1.
2.
Glomerulopati primer
Glomerulopati sekunder:
a. infeksi: sifilis, malaria, TBC, tifus,virus
b. nefrotoksin: diuretik merkuri, bismuth,
preparat emas
c. allergen: sengatan lebah, gigitan ular, tepung
sari.
d. peny.kolagen: SLE, PAN,dermatomiositis,
peny.Goodpastur, giant cell arteritis.
e. peny.lain: Hodgkin, mieloma, leukemi, DM,
feokromositoma, miksedema, gagal
jantung kongestif, SBE, perikarditis
konstriktif, amiloidosis, trombosis vena
renalis, obstruksi vena cava inferior.
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Nephrotic Syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria
Gejala klinis:
kencing berbuih
Sembab tungkai yg progresif s/d
anasarka
Sesak nafas (bila ada cairan pleura)
Sebah dan perut buncit (bila ada asites)
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Pemeriksaan &
diagnosis
1.urinalisis: - proteinuri +3 +4, lipiduria
- torak eritrosit: khas utk SN prim
- glukosuri: bila ok DM.
2.ekskresi protein 24 jam (Esbach)
3.kadar albumin serum
4. Elektroforesa protein serum & protein urin
5.kadar lipid plasma
6.tes imunologi
7.pem.radiologi: BOF, IVP, foto thorax
8. Biopsi ginjal.
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Diagnosis banding:
Penyakit dg edema dan hipoalbuminemi
lain:
1. Penyakit hati kronis
2. Malnutrisi
3. Gagal jantung
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Penatalaksanaan
1. Diet TKTP rendah garam.
2. Obat: a. diuretik
Komplikasi:
1. Kelainan kardiovaskuler
(atherosclerosis)
2. Shock hipovolemi
3. Mudah terserang infeksi
4. Gagal ginjal kronik.
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UTI
UTI (Cystitis):
Evaluation:
Treatment:
Pyelonephritis:
An infection of the renal pelvis and interstitium.
Causes include: kidney stones, reflux, pregnancy,
Glomerulonephritis:
Inflammation of the glomerulus
Glomerular disease is the most common cause
of chronic and end-stage renal failure.
Etiology (Varied):
Types:
Clinical Manifestations:
Urine
1.
2.
3.
Evaluation
Treatment:
Nephrotic Syndrome:
hypoproteinemia, edema.
Characteristic of glomerular injury
Etiology:
Pathophysiology:
Plasma proteins (albumin, immunoglobulins) cross the
injured glomerular filtration membrane. Basement
membrane of the glomerulus looses negative charge.
Hypoalbuminemia ensues. Loss of albumin stimulates
lipoprotein synthesis by the liver and hyperlipidemia.
Evaluation:
Treatment:
Terimakasih
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