SINDROM NEFRITIK VS SINDROM NEFROTIK
Preseptor : dr.. Santoso dr Santo so Chandra. C handra. SpPd Sp Pd
GLOMERULAR Sindrom Nefritik ±
Azotemia,
±
Hipertensi,
±
DISEASE
Sindrom Nefrotik ±
atau 40-50 40-50 mg/kg/hari mg/kg /hari / +3-+ +3-+4 4)
Edema,
±
Hematuria (RBC cast),
±
proteinuria (< 3 g/hr) ,
±
terkadang oliguria.
Proteinuria masif (> 3.5 gram / 24 jam / 1,73 m 2
±
Hipoalbuminemia,
±
Edema anasarka,
±
Hiperlipidemia,
±
Lipiduria.
Sindroma Nefritik Glomerulonefritis akut (GNA) Sindroma Nefritik / GNA adalah sindroma klinik yg ditandai kelainan : ± ± ± ± ± ±
Azotemia,
Hipertensi, Edema, Hematuria (RBC cast), proteinuria (< 3 g/hr) , terkadang oliguria.
Etiologi : 1.
2.
3.
Glomerulopati (GP) idiopatik /primer a. GP akut proliferatif b. GP mesangio proliferatif (IgA) (penyakit Burger) c. GP membranoproliferatif. Infeksi : a. post-infection streptococcus Fhaemolitik 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. Sistemik : Lupus Nephritis, Vaskulitis, Good pasteur syndrome.
Patogenesis Inflamatory process ±
±
Degree of glomerular inflamation the sverity of renal dysfunction and associated clinical manifestations. Poststreptococcal glomerulonephritis tissue injury or result in inflammatory reaction.
Patofisiologi 1. Kel. urinalisis: ok. Kerusakan dd. Kapiler glomerulus selektif proteinuri < 3 g/hr, hematuria disertai silinder eritrosit. 2. LFG menurun, disertai reabsorbsi Na. dan air sehingga terjadi oliguri ,edema, edema paru dan hipertensi.
Gejala klinis: 1. hipertensi (malignant in some cases). 2. Edema 3.
Oliguria
4.
Physical examination : a. SLE Malar Rash, Oral ulcers b. Henoch-schonlein purpura and cryoglobulinemia palpable purpura
Laboratorium Urinalisis Macroscopic hematuria (tea cola colored urine) Microscopic urine reveals RBCs Proteinuria (< 3gr/hari)
Hematologi ±
Anemia
±
Underlying disease : Trombocytopenia or leukopenia (SLE) Blood cultures fever & murmur
Streptozyme & ASO sore throat etc
Imaging
Pulmonary Edema Wageners Granulomatosis & good pasteur disease
Echocardiogram pericardia effusion or endocarditis
USG Renal Kidney Size ( <9 cm Extensive renal Scarring)
Biopsi Untuk diagnosis dan membedakan antara penyebab primer dan sekunder.
KOMPLIKASI Fluid retention Edema dan Hipertensi Short and long therm renal replacement therapy Renal Insufficiency Resistance to erythropoietin or decreased production anemia
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.
ETIOLOGI Glomerular disease :
Membranous Nephropathy(40%) Minimal change disease (15%) Focal glomerulosclerosis (15%) Membarnoproliferative GN (7%) Masangioproliferatif GN (5%) Immunotactoid and Fibrilary GN
Systemic Causes Diabetes mellitus, SLE, Amyloidosis, HIV-associated nephropathy Drugs : Gold, Penicillamine, probenecid, street heroin, captopril, NSAIDs Infection : bacterial endocarditis , hepatitis B, shunt Infection, shypilis, malaria, hepatic schistosomiasis Malignancy : multiple myeloma, light chain deposition disease, hodgkins and other lymphomas, leukemia, carcinoma of breast, GI tract.
Patogenesis Reflects noninflammatory damage glomerular capillary wall.
Proteinuria from alterations in the charge or size selectivity of the glomerular capillary wall.
Patofisiologi
Gejala Klinik Proteinuria Asymptomatic Edema Edem (High Intravascular hydrostatic pressure and tissue hydrostatic pressure) edem anasarka.
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
Polarized light maltese crosses
Hematologi Serum albumin <3 g/dL Total serum protein <6 g/dL Hyperlipidemia BUN dan Kreatinin >> , GFR normal. Anemia,
Elevated erythrocyte sedimentation Rate (ESR), Hypocalcemia nad Vit. D deficiency.
Biopsi
Kontroversi Standar procedure determining the cause of proteinuria.
TERIMA KASIH
From Current diagnosis & treatment Nephrology & Hypertension Chapter 23. nephrotic syndrome vs nephritic Harrison manual of medicine
