Sindroma Nefrotik vs Nefritik

5/21/2018 Sindroma Nefrotik vs Nefritik

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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

Sindroma Nefrotik vs Nefritik

Documents

gp akut proliferatifb

disertai reabsorbsi

good pasteur syndrome

airsehingga terjadi

minimal change disease

edema parudan hipertensi

gp membranoproliferatif