Problem batu ginjal

Penyebab utama batu ginjal belum diketahui

Bentuk utama batu :
Calcium,

struvite,

asam urat,

cystine
 The prevalence of kidney stones is three times higher in
men than women, and is higher among Caucasians
than Asians or African Americans, for reasons that
are not clear.
 They are especially likely to strike between the ages of 40
and 60.
 Nutritional steps are important in preventing stones
and can also help prevent recurrences, which is
important given that 30-50 percent of people diagnosed
with a renal stone have a recurrence within five years.
 Preventing stones is like keeping a salt crystal from
forming in a glass of salty water. You can either
reduce the concentration of salt or add more water.
 Epidemiologic studies have shown that certain parts of the
diet help reduce the amount of calcium that filters into the
urine. It is a simple matter to put these factors to work
clinically.
 Batu calcium
 70%-80% tersusun dari calcium oksalat
dengan atau tanpa fosfat
 Kelebihan calcium dalam urine dapat
disebabkan oleh :
 1. intake berlebihan makanan yang
mengandung calcium tinggi
 2. kelebihan vitamin D,absorbsi calcium
 3. imobilisasi lama
 4. hiperparatiroidism  ekskresi calcium
 Batu struvite
 Terdiri dari MgNH4PO4
 Sering disebut batu infeksi
 Tidak berhubungan dengan makanan
spesifik
 Tidak ada terapi diet spesifik
 Biasanya berukuran besar  perlu operasi
 Angka kejadiannya : sering
 Batu asam urat
 Kelebihan ekskresi asam urat, gangguan
metabolisme purin.
 Terjadi pada penyakit gout, atau karena
pemecahan jaringan yang cepat selama
‘kelaparan’
 Batu cystine
 Angka kejadiannya jarang
 Terjadi karena defect genetik pada
metabolisme asam amino cystine, akan
terjadi gangguan reabsorbsi asam amino
cystine cystinuria
 Terjadi pada anak dengan riwayat
penyakit genetik
 Tanda-tanda klinis
 Tanda utama batu ginjal :Nyeri hebat, general
weakness, kadang ada panas
 Pengelolaan :
 Intake cairan : banyak minum urine encer
mencegah akumulasi material pembentuk batu
 Membatasi diet sesuai dengan komposisi
batumenghambat kekambuhan
 Mengatur pH urine
 Binding agents : mis, sodium phytate untuk mengikat
calcium, dan aluminium gel untuk mengikat fosfat,
glisin untuk mengikat oksalat dalam usus 
menghambat absorbsi, dan mengeluarkan dari tubuh.
 Diit pada batu ginjal
 Memperlambat pertumbuhan batu ginjal
atau membantu mencegah pembentukan
batu ginjal
 Perencanaan nutrisi dihubungkan dengan
jenis batu.
 Mengurangi jenis makanan yang berperan
dalam pembentukan batu.
Macam diit dan indikasi pemberian

 Diit rendah calcium tinggi sisa asam

 Diberikan pada penderita dengan batu Kalsium : Ca
Fosfat, Ca carbonat, dan Ca oksalat.
 Makanan ini cukup kalori, protein, besi, vitaminA,
thiamin dan vitamin C
 Syarat : banyak cairan ; 2500 ml/hari,

rendah calsium : 400mg/hari

Makanan yang boleh diberikan :
KH : beras, bulgur,roti,mie, makaroni, bihun, tepung-
tepungan
Protein hewani : telur, daging, unggas, ikan tanpa
tulang
 Makanan yang boleh diberikan
 Protein nabati : tahu/tempe maks 50 g/hari, kacang-
kacangan kering maks: 25 g/hari
 Lemak : minyak,mentega, margarin
 Sayuran : semua kecuali yang dilarang maks : 200 g/
hari
 Buah : semua buah- buahan segar maks: 200 g/ hari
 Makanan yang tidak boleh diberikan
 KH : kentang, ubi,singkong, biskuit dan kue yang dibuat
dengan susu
 Protein hewani : susu,keju, udang, kepiting, ikan teri,
ikan asin, sardin, otak, ginjal, hati,jantung
 Sayuran : bayam, daun mangkokan, daun melinjo, daun
pepaya, daun lamtoro, daun singkong, daun talas, daun
katuk, daun kelor, jantung pisang, buah melinjo, sawi,
leunca.
 Buah-buahan : semua buah-buahan yang dikeringkan
 Minuman : yang mengandung soda, coklat, soda kue,
yeast
 Diit tinggi sisa basa
 Diberikan pada penderita dengan batu cystine dan asam urat,
makanan ini cukup kalori, mineral, dan vitamin
 Syarat : banyak cairan : 2500 ml/hari, rendah asam amino yang
mengandung sulfur
 Makanan yang bpleh diberikan :
KH : nasi maks: ½ gelas/ hari, roti 4 potong, kentang ubi,singkong,
kue-kue yang dibuat dari tepung maezena, hunkwee, tapioka, agar-
agar, sirop.
Protein hewani : daging 50 g, atau telor: 1 bt/ hari, susu.
Lemak : minyak, mentega, margarin
Protein nabati : kacang-kacangan kering :25g/hari atau tahu,
tempe,oncom : 50 g/hari
sayuran : semua sayuran paling sedikit 300 g/hari
buah-buahan : semua buah-buahan paling sedikit 300 g/hari
minuman : sari buah, the kopi, coklat
 Diit rendah purin
 Tujuan :
 Mengurangi pembentukan asam urat
 Menurunkan berat badan bila pasien gemuk, dan

mempertahankan BB dalam batas normal

Syarat :
Rendah purin : 120-150 mg/hari, normal : 600-1000 mg/hari
Cukup kalori, protein, mineral, dan vitamin
Tinggi hidrat arang, untuk membantu pengeluaran asam urat
Lemak sedang : cenderung menghambat pengeluaran asam urat
Banyak cairan ; membantu mengeluarkan kelebihan asam urat
 Bahan makan yang boleh diberikan :
 KH : semua
 Protein hewani : daging, ayam, ikan tongkol, ikan
tenggiri, bawal, bandeng: 50 g/hari, telor, susu, keju
 Sumber protein nabati : kacang-kacangan kering :
25g/hari atau tahu, tempe, oncom : 50 g/hari
 Lemak : minyak dalam jumlah terbatas
 Sayuran : semua sayuran, kecuali asparagus,
kacang polong, kacang buncis, kembang kol, bayam,
jamur maksimum : 50 g/ hari
 Buah-buahan : semua macam buah
 Minuman : teh, kopi, minuman yang mengandung
soda
 Bumbu : semua macam bumbu
 Makanan yang tidak boleh diberikan
 Sumber protein hewani : sardin, kerang, jantung, hati,
usus,limpa,paru,paru,otak, ekstraks daging/kaldu,
bebek, angsa, burung
 Minuman : alkohol
 Bumbu : ragi
 Protective Foods
 Water.
 Water dilutes the urine and keeps calcium,
oxalates, and uric acid in solution.

 In research studies, those subjects whose total

fluid intake (from all sources) over 24 hours was
roughly 2.5 liters, the risk of a stone was about
one-third less than that of subjects drinking only
half that much. (They do not need to drink 2.5
liters of water per day; rather this is the total
fluid consumption, including juices, soups, etc.)
 High-Potassium Foods.
 A study of 46,000 men conducted by Harvard
University researchers found that a high
potassium intake can cut the risk of kidney
stones in half.
 Potassium helps the kidneys retain calcium,
rather than sending it out into the urine.
Potassium supplements are not generally
necessary. Rather, a diet including regular
servings of fruits, vegetables, and beans
supplies plenty of potassium.
 Calcium.
 Although most stones contain calcium, the calcium in
foods does not necessarily contribute to stones. Calcium
supplements taken between meals may increase the risk
of stones, because about 8 percent of any extra dietary
calcium passes into the urine.
 On the other hand, calcium consumed with meals has
the opposite effect, reducing the risk of stones. The
reason, apparently, is that calcium binds to oxalates in
foods and holds them in the digestive tract, rather than
allowing them to be absorbed.
 Caffeine.
 Caffeinated beverages reduce the risk of stones.
Caffeine’s diuretic effect causes the loss of both
water and calcium, but the water loss is
apparently the predominant effect.
 alcoholic beverages are associated with a
reduced risk of kidney stones, again presumably
due to a diuretic effect. This is not a compelling
reason to drink either coffee or alcohol, but their
diuretic actions do present this advantage.
 Problem Foods

Animal proteins cause calcium to be leached from the

bones and excreted in the urine where it can form
stones.
Diets rich in animal proteins also increase uric acid
excretion. In a controlled research study, published in
the American Journal of Clinical Nutrition, research
subjects on a diet eliminating animal protein had less
than half the calcium loss that they had on their baseline
diet.
 The Harvard study mentioned earlier found that even a
modest increase in animal protein, from less than 50
grams to 77 grams per day, was associated with a 33
percent increased risk of stones in men. The same is
true for women.
 The association between animal proteins and stones probably
relates both to the amount of protein they contain and to their
content of the sulfur-containing amino acids

 Sulfur in cystine and methionine is converted to sulfate, which

tends to acidify the blood. As a part of the process of neutralizing
this acid, bone is dissolved, and bone calcium ends up in the urine.
Meats and eggs contain two to five times more of these sulfur-
containing amino acids than are found in grains and beans.

 Between 1958 and the late 1960s, there was a sharp increase in the
incidence of kidney stones in Great Britain. During that period, there
was no substantial change in the amount of calcium or oxalate-
containing foods consumed. However, the consumption of
vegetables decreased, and the use of poultry, fish, and red meat
increased. Statistical analyses showed a strong relationship between
the incidence of stones and animal protein consumption.
 Sodium.
 Sodium increases the passage of calcium through the
kidney and increases the risk of stones. When people cut
their salt (sodium chloride) intake in half, they reduce
their daily need for calcium by about 160 milligrams.

 Plants of any kind—grains, vegetables, legumes, and

fruits—contain almost no sodium at all unless it is added
during canning or other processing. Dairy products and
meats contain more salt than plant products, and table
salt, frozen meals, and canned and snack foods are the
highest-sodium food products.
 Surprisingly,
 oxalate-rich foods, such as chocolate,
nuts, tea, and spinach, are not associated
with a higher risk of renal stones, nor is
vitamin C, even though it can be
converted to oxalate. A large study of men
taking vitamin C supplements found that
they had no more kidney stones than men
who do not take them.
Sugar.
Sugar accelerates calcium losses through the kidney.
In the Nurses’ Health Study, those who consumed, on
average, 60 grams or more of sugar (sucrose) per day
had a 50 percent higher risk of stones than those who
consumed only about 20 grams.
Climate. Kidney stones are also more common in warm
climates, presumably because perspiration leads to
dehydration and a more concentrated urine, and
because sunlight increases the production of vitamin D
in the skin which, in turn, increases calcium absorption
from the digestive tract.17
Here are simple steps to help your
patients avoid kidney stones.
 Encourage patients to drink plenty of water or
other fluids, staying ahead of their thirst.
 Diets including generous amounts of vegetables,
fruits, and beans are rich in potassium and very
low in sodium.
 If you prescribe calcium supplements, encourage
patients to take them with meals, rather than
between meals.
 Encourage patients to avoid animal products.
Their proteins and sodium content increase the
risk of stones.
 Patients should keep salt and sugar use modest.