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SINDROM NEFRITIKVS
SINDROM NEFROTIK
Preseptor :dr. Santoso Chandra. SpPd
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GLOMERULAR DISEASE
Sindrom Nefritik
Azotemia,
Hipertensi, Edema,
Hematuria(RBC cast),
proteinuria (< 3 g/hr),
terkadang oliguria.
Sindrom Nefrotik
Proteinuria masif (> 3.5
gram / 24 jam / 1,73 m2
atau 40-50 mg/kg/hari /
+3-+4)
Hipoalbuminemia,
Edema anasarka,
Hiperlipidemia,
Lipiduria.
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Sindroma Nefritik
Glomerulonefritis akut (GNA)
Sindroma Nefritik / GNA adalah sindroma klinikyg ditandai kelainan :
Azotemia,
Hipertensi,
Edema,
Hematuria(RBC cast), proteinuria (< 3 g/hr),
terkadang oliguria.
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Etiologi :
1. Glomerulopati (GP) idiopatik /primer
a. GP akut proliferatif
b. GP mesangio proliferatif (IgA)
(penyakit Burger)
c. GP membranoproliferatif.2. Infeksi :
a. post-infection streptococcus haemolitik
b. Non Streptococcal :
endokarditis bakterialis (nefritis Lohlein)
sepsis, pneumococcal pneumonia, thypoid fever, etc.c. parasit : malaria, toxoplasmosis, etc.
d. Viral : hepatitis B, mumps, measles, varicella, etc.
3. Sistemik : Lupus Nephritis, Vaskulitis, Good pasteur syndrome.
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Patogenesis
Inflamatory process
Degree of glomerular inflamationthe sverity of
renal dysfunction and associated clinical
manifestations.
Poststreptococcal glomerulonephritistissue
injury or result in inflammatory reaction.
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Patofisiologi
1. Kel. urinalisis: ok. Kerusakan dd. Kapiler
glomerulusselektif proteinuri < 3 g/hr,
hematuria disertai silinder eritrosit.
2. LFG menurun, disertai reabsorbsi Na. dan air
sehingga terjadi oliguri ,edema, edema paru
dan hipertensi.
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Gejala klinis:
1. hipertensi (malignant in some cases).
2. Edema
3. Oliguria4. Physical examination :
a. SLEMalar Rash, Oral ulcers
b. Henoch-schonlein purpura andcryoglobulinemiapalpable purpura
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Laboratorium
Urinalisis
Macroscopic hematuria (teacola colored
urine)
Microscopic urine reveals RBCs
Proteinuria (< 3gr/hari)
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Hematologi
Anemia
Underlying disease :
Trombocytopenia or leukopenia (SLE)
Blood culturesfever & murmur
Streptozyme & ASOsore throat
etc
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Imaging
Pulmonary EdemaWageners
Granulomatosis & good pasteur disease
Echocardiogrampericardia effusion or
endocarditis
USG RenalKidney Size (
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Biopsi
Untuk diagnosis dan membedakan antara
penyebab primer dan sekunder.
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KOMPLIKASI
Fluid retentionEdema dan Hipertensi
Short and long therm renal replacement
therapyRenal Insufficiency
Resistance to erythropoietin or decreased
productionanemia
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SINDROM NEFROTIK
Merupakan salah satu gambaran klinik
penyakit glomerulus yang ditandai dengan :
Proteinuria masif (> 3.5 gram / 24 jam / 1,73 m2)
atau 40-50 mg/kg/hari
Hipoalbuminemia,
Edema anasarka,
Hiperlipidemia, dan
Lipiduria.
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ETIOLOGI
Glomerular disease :
Membranous Nephropathy(40%)
Minimal change disease (15%) Focal glomerulosclerosis (15%)
Membarnoproliferative GN (7%)
Masangioproliferatif GN (5%) Immunotactoid and Fibrilary GN
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Systemic Causes
Diabetes mellitus, SLE, Amyloidosis, HIV-associatednephropathy
Drugs : Gold, Penicillamine, probenecid, street heroin,captopril, NSAIDs
Infection : bacterial endocarditis, hepatitis B, shuntInfection, shypilis, malaria, hepatic schistosomiasis
Malignancy : multiple myeloma, light chain depositiondisease, hodgkinsand other lymphomas, leukemia,carcinoma of breast, GI tract.
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Patogenesis
Reflects noninflammatory damage
glomerular capillary wall.
Proteinuriafrom alterations in the charge
or size selectivity of the glomerular capillary
wall.
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Patofisiologi
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Gejala Klinik
ProteinuriaAsymptomaticEdema
Edem (High Intravascular hydrostatic pressure
and tissue hydrostatic pressure)edem
anasarka.
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Laboratorium
Urinalisis
Proteinuria (urine dipstick +3 to +4 dan 24
hour urine collection >3.5 g protein/1.73 m2)
Few cells or cast and
Urinary lipid in sediment
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Polarized lightmaltese crosses
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Hematologi
Serum albumin , GFR normal.
Anemia, Elevated erythrocyte sedimentationRate (ESR), Hypocalcemia nad Vit. D
deficiency.
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Biopsi
KontroversiStandar procedure determining
the cause of proteinuria.
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TERIMA KASIH
From Current diagnosis & treatment Nephrology & Hypertension
Chapter 23. nephrotic syndrome vs nephritic
Harrison manual of medicine