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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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3

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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4

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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6

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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7

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