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Problem batu ginjal

Penyebab utama batu ginjal belum diketahui

Bentuk utama batu :

Calcium,

struvite,

asam urat,

cystine

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The prevalence of kidney stones is three times higherin men than women, and is higher amongCaucasians than Asians or African Americans, forreasons that are not clear.

They are especially likely to strike between the ages of40 and 60.

Nutritional steps are important inpreventing stonesand can also help prevent recurrences, which isimportant given that 30-50 percent of people diagnosedwith a renal stone have a recurrence within five years.

Preventing stones is like keeping a salt crystalfrom forming in a glass of salty water. You caneither 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 filtersinto the urine. It is a simple matter to put these factorsto work clinically.

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Batu calcium

70%-80% tersusun dari calcium oksalatdengan 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

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Batu struvite

Terdiri dari MgNH4PO4

Sering disebut batu infeksi

Tidak berhubungan dengan makananspesifik

Tidak ada terapi diet spesifik

Biasanya berukuran besar perlu operasiAngka kejadiannya : sering

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Batu asam urat

Kelebihan ekskresi asam urat, gangguanmetabolisme purin.

Terjadi pada penyakit gout, atau karenapemecahan jaringan yang cepat selama

kelaparan

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Batu cystine

Angka kejadiannya jarang

Terjadi karena defect genetik padametabolisme asam amino cystine, akanterjadi gangguan reabsorbsi asam aminocystine cystinuria

Terjadi pada anak dengan riwayatpenyakit genetik

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Tanda-tanda klinis

Tanda utama batu ginjal :Nyeri hebat, generalweakness, kadang ada panas

Pengelolaan : Intake cairan : banyak minum urine encer

mencegah akumulasi material pembentuk batu Membatasi diet sesuai dengan komposisi

batumenghambat 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.

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Diit pada batu ginjal

Memperlambat pertumbuhan batu ginjalatau membantu mencegah pembentukanbatu ginjal

Perencanaan nutrisi dihubungkan denganjenis batu.

Mengurangi jenis makanan yang berperandalam pembentukan batu.

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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-

tepunganProtein hewani : telur, daging, unggas, ikan tanpa

tulang

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Makanan yang boleh diberikan

Protein nabati : tahu/tempe maks 50g/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

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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, daunkatuk, daun kelor, jantung pisang, buah melinjo, sawi,leunca.

Buah-buahan : semua buah-buahan yang dikeringkan

Minuman : yang mengandung soda, coklat, soda kue,yeast

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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 yangmengandung sulfur

Makanan yang bpleh diberikan :

KH: nasi maks: 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/haribuah-buahan: semua buah-buahan paling sedikit 300 g/hari

minuman : sari buah, teh, kopi, coklat

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Diit rendah purin

Tujuan :

Mengurangi pembentukan asam urat

Menurunkan berat badan bila pasien gemuk, danmempertahankan BB dalam batas normal

Syarat :

Rendah purin : 120-150 mg/hari, normal : 600-1000 mg/hariCukup 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

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Bahan makan yang boleh diberikan : KH : semua

Protein hewani : daging, ayam, ikan tongkol, ikantenggiri, 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 mengandungsoda

Bumbu : semua macam bumbu

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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

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Protective Foods

Water. Water dilutes the urine and keeps calcium,

oxalates, and uric acid in solution.

In research studies, those subjects whose totalfluid intake (from all sources) over 24 hours wasroughly 2.5 liters, the risk of a stone was aboutone-third less than that of subjects drinking only

half that much. (They do not need to drink 2.5liters of water per day; rather this is the totalfluid consumption, including juices, soups, etc.)

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High-Potassium Foods.

A study of 46,000 men conducted by HarvardUniversity researchers found that a high

potassium intake can cut the risk of kidneystones in half.

Potassium helps the kidneys retain calcium,rather than sending it out into the urine.

Potassium supplements are not generallynecessary. Rather, a diet including regularservings of fruits, vegetables, and beanssupplies plenty of potassium.

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Calcium.

Although most stones contain calcium, the calcium infoods does not necessarily contribute to stones. Calciumsupplements taken between meals may increase the risk

of stones, because about 8 percent of any extra dietarycalcium passes into the urine.

On the other hand, calcium consumed with meals hasthe opposite effect, reducing the risk of stones. Thereason, apparently, is that calcium binds to oxalates in

foods and holds them in the digestive tract, rather thanallowing them to be absorbed.

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Caffeine.

Caffeinated beverages reduce the risk of stones.Caffeines diuretic effect causes the loss of both

water and calcium, but the water loss isapparently the predominant effect.

alcoholic beverages are associated with areduced risk of kidney stones, again presumably

due to a diuretic effect. This is not a compellingreason to drink either coffee or alcohol, but theirdiuretic actions do present this advantage.

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Problem Foods

Animal proteins cause calciumto be leached from thebones and excreted in the urine where it can formstones.Diets rich in animal proteins also increase uric acidexcretion. In a controlled research study, published intheAmerican Journal of Clinical Nutrition, researchsubjects on a diet eliminating animal protein had lessthan half the calcium loss that they had on their baselinediet.

The Harvard study mentioned earlier found that even a

modest increase in animal protein, from less than 50grams to 77 grams per day, was associated with a 33percent increased risk of stones in men. The same istrue for women.

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The association between animal proteins and stones probablyrelates both to the amount ofproteinthey contain and to theircontent of the sulfur-containing amino acids

Sulfur in cystine and methionineis converted to sulfate, whichtends to acidify the blood. As a part of the process of neutralizingthis 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 theincidence of kidney stones in Great Britain. During that period, therewas no substantial change in the amount of calcium or oxalate-containing foods consumed. However, the consumption ofvegetables decreased, and the use of poultry, fish, and red meatincreased. Statistical analyses showed a strong relationship between

the incidence of stones and animal protein consumption.

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Sodium.

Sodium increases the passage of calcium through thekidney and increases the risk of stones. When people cuttheir salt (sodium chloride) intake in half, they reduce

their daily need for calcium by about 160 milligrams.

Plants of any kindgrains, vegetables, legumes, andfruitscontain almost no sodium at all unless it is addedduring canning or other processing. Dairy products andmeats contain more salt than plant products, and tablesalt, frozen meals, and canned and snack foods are thehighest-sodium food products.

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Surprisingly,

oxalate-rich foods, such as chocolate,nuts, tea, and spinach, are not associated

with a higher risk of renal stones, nor isvitamin C, even though it can beconverted to oxalate. A large study of mentaking vitamin C supplements found thatthey had no more kidney stones than menwho do not take them.

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Sugar.

Sugar accelerates calcium losses through the kidney.

In the Nurses Health Study, those who consumed, onaverage, 60 grams or more of sugar (sucrose) per day

had a 50 percent higher risk of stones than those whoconsumed only about 20 grams.

Climate. Kidney stones are also more common in warmclimates, presumably because perspiration leads todehydration and a more concentrated urine, andbecause sunlight increases the production of vitamin Din the skin which, in turn, increases calcium absorptionfrom the digestive tract.17

Here are simple steps to help your

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Here are simple steps to help your

patients avoid kidney stones.

Encourage patients to drink plenty of water orother 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 therisk of stones.

Patients should keep salt and sugar use modest.